The assessment of therapist responsiveness in psychotherapy research: a systematic review

Submitted: January 16, 2024
Accepted: May 13, 2024
Published: June 19, 2024
Abstract Views: 59
PDF: 63
SUPPLEMENTARY MATERIAL: 9
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

Therapist responsiveness is an emerging construct in psychotherapy research that still lacks a clear definition and, consequently, a unique operationalization. Indeed, there is a great overlap between therapist responsiveness and other variables, such as attunement, flexibility, and empathy. This overlap inevitably hinders the assessment of the therapist’s responsiveness, although it is crucial for the effectiveness of the treatments. Therefore, the current systematic review aims at exploring the different methodologies of measurement and analysis of therapist responsiveness, including both direct and indirect instruments. The results confirmed difficulties and divergences in the operationalization of the construct, as shown by the great heterogeneity found in the choice and use of the tools. Furthermore, this review provides guidance for future research, clinical practice, and training of therapists.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

Barker, T. H., Stone, J. C., Sears, K., Klugar, M., Tufanaru, C., Leonardi-Bee, J., Aromataris, E., & Munn, Z. (2023). The revised JBI critical appraisal tool for the assessment of risk of bias for randomized controlled trials. JBI Evidence Synthesis, 21(3), 494-506. doi: 10.11124/JBIES-22-00430. DOI: https://doi.org/10.11124/JBIES-22-00430
Cahill, J., Barkham, M., Hardy, G., Gilbody, S., Richards, D., Bower, P., & Connell, J. (2009). A review and critical appraisal of measures of therapist-patient interactions in mental health settings. Health Technology Assessment, 12(24), iii. doi: 10.1108/cgij.2009.24814aaf.003. DOI: https://doi.org/10.3310/hta12240
Culina, I., Fiscalini, E., Martin-Soelch, C., & Kramer, U. (2022). The first session matters: therapist responsiveness and the therapeutic alliance in the treatment of borderline personality disorder. Clinical Psychology & Psychotherapy, 30(1), 131-140. doi: 10.1002/cpp.2783. DOI: https://doi.org/10.1002/cpp.2783
Elkin, I., & Smith, Y. (2007). Therapist responsiveness study rating scale. School of Social Service Administration, University of Chicago, Chicago, Illinois.
Elkin, I., Falconnier, L., Smith, Y., Canada, K. E., Henderson, E., Brown, E. R., & Mckay, B. M. (2014). Therapist responsiveness and patient engagement in therapy. Psychotherapy Research, 24(1), 52-66. doi: 10.1080/10503307.2013.820855. DOI: https://doi.org/10.1080/10503307.2013.820855
Erskine, R. G. (1998). Attunement and involvement: therapeutic responses to relational needs. International Journal of Psychotherapy, 3(3), 235-244.
Esposito, G., Di Maro, A., & Passeggia, R. (2024). The relationship between treatment integrity and outcome in group psychotherapy: A systematic review. Clinical Psychology & Psychotherapy, 31(1), 1-17. doi: 10.1002/cpp.2952 DOI: https://doi.org/10.1002/cpp.2952
Esposito, G., Passeggia, R., Cutolo, A. S., Karterud, S., & Freda, M. F. (2020). Treatment integrity and members’ change in group counseling: A pilot study on counselor’s mentalizing interventions. Professional Psychology: Research and Practice, 51(6), 588-597. doi: 10.1037/pro0000304 DOI: https://doi.org/10.1037/pro0000304
Eubanks, C. F., Lubitz, J., Muran, J. C., & Safran, J. D. (2019). Rupture resolution rating system (3RS): development and validation. Psychotherapy Research, 29(3), 306-319. doi:10.1080/10503307.2018.1552034. DOI: https://doi.org/10.1080/10503307.2018.1552034
Eubanks, C. F., Sergi, J., & Muran, J. C. (2021). Responsiveness to ruptures and repairs in psychotherapy. In Watson, J. C., & Wiseman, H. (Eds.), The responsive psychotherapist: attuning to clients in the moment (pp.83-103). American Psychological Association. DOI: https://doi.org/10.1037/0000240-005
Gelo, O. C. G., Pritz, A., & Rieken, B. (2015). Preface. In O. C. G. Gelo, A. Pritz, & B. Rieken (Eds.), Psychotherapy research: Foundations, process, and outcome. Springer. DOI: https://doi.org/10.1007/978-3-7091-1382-0
Gelo, O. C. G., Salcuni, S., & Colli, A. (2012). Text analysis within quantitative and qualitative psychotherapy process research: Introduction to special issue. Research in Psychotherapy: Psychopathology, Process and Outcome, 15(2), 45–53. https://doi.org/10.7411/RP.2012.005 DOI: https://doi.org/10.4081/ripppo.2012.144
Gelso, C. J., Kelley, F. A., Fuertes, J. N., Marmarosh, C., Holmes, S. E., Costa, C., & Hancock, G. R. (2005). Measuring the real relationship in psychotherapy: initial validation of the therapist form. Journal of counseling psychology, 52(4), 640-649. doi: 10.1037/0022-0167.52.4.640. DOI: https://doi.org/10.1037/0022-0167.52.4.640
Hatcher, R. L. (2015). Interpersonal competencies: responsiveness, technique, and training in psychotherapy. American Psychologist, 70(8), 747-757. doi: 10.1037/a0039803. DOI: https://doi.org/10.1037/a0039803
Hatcher, R. L. (2021). Responsiveness, the relationship, and the working alliance in psychotherapy. In Watson, J. C., & Wiseman, H. (Eds.), The responsive psychotherapist: attuning to clients in the moment (pp. 37-58). American Psychological Association. DOI: https://doi.org/10.1037/0000240-003
Hatcher, R. L., & Gillaspy, J. A. (2006). Development and validation of a revised short version of the working alliance inventory. Psychotherapy research, 16(1), 12-25. doi: 10.1080/10503300500352500. DOI: https://doi.org/10.1080/10503300500352500
Kendall, P. C., & Frank, H. E. (2018). Implementing evidencebased treatment protocols: flexibility within fidelity. Clinical Psychology: Science and Practice, 25(4), e12271. doi: 10.1111/cpsp.12271. DOI: https://doi.org/10.1111/cpsp.12271
Kivlighan, Jr, D. M., Kline, K., Gelso, C. J., & Hill, C. E. (2017). Congruence and discrepancy between working alliance and real relationship: Variance decomposition and response surface analyses. Journal of Counseling Psychology, 64(4), 394-409. doi: 10.1037/cou0000216. DOI: https://doi.org/10.1037/cou0000216
Kramer, U., Flückiger, C., Kolly, S., Caspar, F., Marquet, P., Despland, J. N., & De Roten, Y. (2014). Unpacking the effects of therapist responsiveness in borderline personality disorder: motive-oriented therapeutic relationship, patient in-session experience, and the therapeutic alliance. Psychotherapy and Psychosomatics, 83(6), 386-387. doi: 10.1159/000365400. DOI: https://doi.org/10.1159/000365400
Kramer, U., Pascual-Leone, A., Rohde, K. A., & Sachse, R. (2016). Emotional processing, interaction process, and outcome in clarification-oriented psychotherapy for personality disorders: a process-outcome analysis. Journal of Personality Disorders, 30(3), 373-394. doi: 10.1521/pedi_2015_29_204. DOI: https://doi.org/10.1521/pedi_2015_29_204
Lockwood, C., Munn, Z., & Porritt, K. (2015). Qualitative research synthesis: methodological guidance for systematic reviewers utilizing meta-aggregation. International Journal of Evidence-Based Healthcare, 13(3), 179-187. doi: 10.1097/XEB.0000000000000062. DOI: https://doi.org/10.1097/XEB.0000000000000062
Marques, L., Valentine, S. E., Kaysen, D., Mackintosh, M. A., Dixon De Silva, L. E., Ahles, E. M., Youn, S. J., Shtasel, D. L., Simon, N. M., & Wiltsey-Stirman, S. (2019). Provider fidelity and modifications to cognitive processing therapy in a diverse community health clinic: Associations with clinical change. Journal of Consulting and Clinical Psychology, 87(4), 357-369. doi: 10.1037/ccp0000384. DOI: https://doi.org/10.1037/ccp0000384
McAleavey, A. A., & Castonguay, L. G. (2014). The process of change in psychotherapy: common and unique factors. In O. C. G. Gelo, A. Pritz, & B. Rieken (Eds.), Psychotherapy research: foundations, process, and outcome (pp. 293-310). Springer Vienna. DOI: https://doi.org/10.1007/978-3-7091-1382-0_15
Messina, I., Gelo, O. C. G., Sambin, M., Bianco, F., Mosconi, A., Fenelli, A., Curto, M., Gullo, S., & Orlinsky, D. (2018). Trainees’ self-evaluation of their development as psychotherapists: An Italian contribution to an international collaborative study on psychotherapy training. Clinical Psychology & Psychotherapy, 25(2), 338–347. https://doi.org/10.1002/cpp.2165 DOI: https://doi.org/10.1002/cpp.2165
Meystre, C., Kramer, U., De Roten, Y., Despland, J. N., & Stiles, W. B. (2014). How psychotherapeutic exchanges become responsive: a theory-building case study in the framework of the assimilation model. Counselling and Psychotherapy Research, 14(1), 29-41. doi: 10.1080/14733145.2013.782056. DOI: https://doi.org/10.1080/14733145.2013.782056
Moola S., Munn Z., Tufanaru C., Aromataris E., Sears K., Sfectu R., Currie M., Qureshi R., Mattis P., Lisy K., & Mu P-F. (2020). Chapter 7: Systematic reviews of etiology and risk. In: Aromataris E., & Munn Z (Eds.), JBI Manual for Evidence Synthesis. JBI. DOI: https://doi.org/10.46658/JBIRM-17-06
Page, M. J., Moher, D., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo- Wilson, E., McDonald, S., McGuinness, L. A., Stewart, L. A., Thomas, J., Tricco, A. C., Welch, V. A., Whiting, P., & McKenzie, J. E. (2021). PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. British Medical Journal, 372, n160. doi: 10.1136/bmj.n160. DOI: https://doi.org/10.1136/bmj.n160
Reis, H. T. (2014). Responsiveness: affective interdependence in close relationships. In M. Mikulincer & P. R. Shaver (Eds.), Mechanisms of social connection: from brain to group (pp. 255-271). American Psychological Association. doi: 10.1037/14250-015. DOI: https://doi.org/10.1037/14250-015
Richards, D., Timulak, L., & Hevey, D. (2013). A comparison of two online cognitive-behavioural interventions for symptoms of depression in a student population: the role of therapist responsiveness. Counselling and Psychotherapy Research, 13(3), 184-193. doi: 10.1080/14733145.2012.733715. DOI: https://doi.org/10.1080/14733145.2012.733715
Sachse, R., Schülken, T., Leisch, M., & Sachse, M. (2011). Effektivität Klärungsorientierter Psychotherapie: erste Ergebnisse. In R. Sachse, J. Fasbender, J. Breil, & M. Sachse (Eds.), Perspektiven Klärungsorientierter Psychotherapie II (pp. 239-276). Lengerich: Pabst Science Publishers. [Material in German].
Siddaway, A. P., Wood, A. M., & Hedges, L. V. (2019). How to do a systematic review: a best practice guide for conducting and reporting narrative reviews, meta-analyses, and meta-syntheses. Annual review of psychology, 70, 747-770. doi: 10.1146/annurev-psych-010418- 102803. DOI: https://doi.org/10.1146/annurev-psych-010418-102803
Silberschatz, G. (2009). The patient’s experience of attunement and responsiveness scale (Unpublished manuscript).
Snyder, J., & Aafjes-van Doorn, K. (2016). Utilizing measure-based feedback in control-mastery theory: a clinical error. Psychotherapy, 53(3), 291-296. doi: 10.1037/pst0000075. DOI: https://doi.org/10.1037/pst0000075
Snyder, J., & Silberschatz, G. (2016). The patient’s experience of attunement and responsiveness scale. Psychotherapy Research, 27(5), 608-619. doi: 10.1080/10503307.2016.1147658. DOI: https://doi.org/10.1080/10503307.2016.1147658
Spagnuolo Lobb, M., Sciacca, F., Iacono Isidoro, S., & Di Nuovo, S. (2022). The therapist’s intuition and responsiveness: What makes the difference between expert and in training Gestalt psychotherapists. European Journal of Investigation in Health, Psychology and Education, 12(12), 1842-1851. doi: 10.3390/ejihpe12120129. DOI: https://doi.org/10.3390/ejihpe12120129
Stiles, W. B. (2002). Assimilation of problematic experiences. In J. C. Norcross (Eds.), Psychotherapy relationships that work: therapist contributions and responsiveness to patients (pp. 357-365). Oxford University Press.
Stiles, W. B. (2021). Responsiveness in psychotherapy research: problems and ways forward. In Watson, J. C., & Wiseman, H. (Eds.), The responsive psychotherapist: attuning to clients in the moment (pp. 15-35). American Psychological Association. doi: 10.1037/0000240-002. DOI: https://doi.org/10.1037/0000240-002
Stiles, W. B., & Horvath, A. O. (2017). Appropriate responsiveness as a contribution to therapist effects. In L. G. Castonguay & C.E. Hill (Eds.), How and why are some therapists better than others? Understanding therapist effects (pp. 71-84). American Psychological Association. doi: 10.1037/0000034-005. DOI: https://doi.org/10.1037/0000034-005
Stiles, W. B., & Wolfe, B. E. (2006). Relationship factors in treating anxiety disorders. In L. G. Castonguay & L. E. Beutler (Eds.), Principles of therapeutic change that work (pp. 155-165). Oxford University Press. DOI: https://doi.org/10.1093/med:psych/9780195156843.003.0007
Stiles, W. B., Honos-Webb, L., & Surko, M. (1998). Responsiveness in psychotherapy. Clinical Psychology: Science and Practice, 5(4), 439-458. doi: 10.1111/j.1468-2850.1998.tb00166.x. DOI: https://doi.org/10.1111/j.1468-2850.1998.tb00166.x
Trijsburg, R. W., Frederiks, G. C. F. J., Gorlee, M., Klouwer, E., Hollander, A. D., & Duivenvoorden, H. J. (2002). Development of the comprehensive psychotherapeutic interventions rating scale (CPIRS). Psychotherapy Research, 12(3), 287-317. doi: 10.1093/ptr/12.3287. DOI: https://doi.org/10.1093/ptr/12.3.287
Watson, J. C., & Wiseman, H. (Eds.). (2021). The responsive psychotherapist: attuning to clients in the moment. American Psychological Association. doi: 10.1037/0000240-000. DOI: https://doi.org/10.1037/0000240-000
Zalaznik, D., Strauss, A. Y., Halaj, A., Barzilay, S., Fradkin, I., Katz, B. A., & Huppert, J. D. (2021). Patient alliance with the program predicts treatment outcomes whereas alliance with the therapist predicts adherence in internet-based therapy for panic disorder. Psychotherapy Research, 31(8), 1022-1035. doi: 10.1080/10503307.2021.1882712. DOI: https://doi.org/10.1080/10503307.2021.1882712
Zuroff, D. C., Kelly, A. C., Leybman, M. J., Blatt, S. J., & Wampold, B. E. (2010). Between-therapist and within-therapist differences in the quality of the therapeutic relationship: effects on maladjustment and self-critical perfectionism. Journal of Clinical Psychology, 66(7), 681-697. doi: 10.1002/jclp.20683. DOI: https://doi.org/10.1002/jclp.20683

How to Cite

Esposito, G., Cuomo, F., Di Maro, A., & Passeggia, R. (2024). The assessment of therapist responsiveness in psychotherapy research: a systematic review. Research in Psychotherapy: Psychopathology, Process and Outcome, 27(1). https://doi.org/10.4081/ripppo.2024.751