Because of its political and philosophical launching ground (Arredondo & Perez, 2006), cultural competence did not begin as an empirical research program, and as a result, there remains disagreement about how to define and measure cultural competence. Although the application of cultural competence remains unclear to some psychologists (Fuertes et al., 2006), it is now common knowledge that the therapeutic alliance is a statistically and clinically significant contributor to effective therapy. This pilot study merges two prominent bodies of literature, cultural competence and therapeutic alliance, with the underlying assumption that a culturally competent counselor will be able to provide effective service through the therapeutic relationship (Pope-Davis et al., 2002). This pilot study was designed to provide information about the relationship between therapists' self-reports and their observed behaviors regarding cultural competence (CC), examine how therapists' CC facilitates the formation of working alliances, and examine the role of CC in predicting parent-child discrepancy in alliance. Participants were family therapists and family members involved in a multi-site clinical trial study (Parent Study) evaluating Brief Strategic Family Therapy (BSFT™; Szapocznik, Hervis, & Schwartz, 2003). A total of 14 therapists from 8 community treatment programs from across the country were included in the rating portion of the study. The Parent Study included African American and Hispanic families with adolescents ages 12-17, mostly referred from the juvenile justice system. Scores from Roysircar's Multicultural Counseling Inventory (MCI; 1994) and Cultural Diversity Observer Rating Scale (CDORS; 2005) were compared. Observed therapeutic alliance was evaluated using the Vanderbilt Therapeutic Alliance Scale-Revised. The associations were evaluated with 3 multilevel univariate linear models using HLM software. Since 6 of 14 therapists (43%) completed the MCI, the pilot study was completed without self-reported competence as a predictor of therapeutic alliance (only CDORS was used). The results of this study failed to provide support for the hypothesized relationships between cultural competence and therapeutic alliance. These results are discussed in light of the methodological limitations of this study and suggestions are made to improve future investigations in this area.

The purpose of this study was to examine the use and effect of figurative language discourse in examples of expert therapy. More specifically, one of the main reasons for conducting this study was to describe figurative language discourse, its production, use, and potential effects on the therapeutic relationship and client experiencing. Training videos were selected and transcribed using criteria for selection of examples of expert therapy. Fifty-six excerpts, each two-minutes in length, were taken from the transcribed therapy sessions and used for the analyses. One set of raters was trained to identify instances of figurative language and make ratings of shared theme. Another set of raters was trained to use the Experiencing Scales and the Working Alliance Inventory on the transcribed excerpts. Analyses were conducted to investigate the frequency of use and relationship between therapist and client figurative language dialogue. Results indicated that the majority of figurative language used in examples of expert therapy is metaphoric in nature. Additionally, it was found that the majority of figures of speech were frozen in meaning or were commonly used. A small percentage of figures of speech were shared conceptually between the therapist and the client. Regarding the shared figurative language, a statistically significant difference between therapists and clients with regard to their production of shared figurative language was found and indicates that use of shared figurative language by expert therapists may be a subtle and indirect way in which therapeutic alliance is initially established as well as maintained. It may also represent how expert therapists follow content of the therapy session. In addition, a regression analysis conducted to determine if there is a relationship between shared figurative language and ratings of therapeutic alliance did not meet statistical significance. Overall, the results of this study provide preliminary findings with regard to what type of figures of speech expert therapists use and give a clear direction in terms of the next direction for research. Additionally, this experiment provides direction for the type of methodology that should be utilized in future research.

The purpose of this research was to describe the use of autohypnosis as a psychotherapeutic intervention with hearing impaired college students specific to four clinical questions: A. Are hearing impaired persons susceptible to hypnosis? B. Can written hypnotic induction be used to introduce hearing impaired persons to relaxation technics? C. Can hearing impaired persons use autohypnosis to achieve a state of relaxation? D. While in a hypnotic state of relaxation can a hearing impaired subject engage in a predetermined fantasy?Eight oral hearing impaired undergraduates, between 18-22 years old, for eight consecutive days completed questionnaires germane to their use of hypnosis. Sixty four questionnaires were submitted to data analysis. Each subject's response as to perceived state of hypnosis was cross-tabulated with: five nonhypnotic state indicators;the amount of time displacement reported per hypnotic session; and three outcome indicators of subject having engaged in predetermined fantasy. The total absolute frequency of incidence(s) of hypnosis having occurred was calculated to be 49 out of 64 reported attempts. The relative frequency percentage was calculated as 75.6% which was interpreted as a descriptive indicator that oral hearing impaired persons utilizing a written autohypnotic technic are susceptible to and can induce, for self, a hypnotic state of relaxation. Additionally it was interpreted that for oral hearing impaired persons the induction technic does not have to deviate extensively from the traditional autohypnotic technic(s) used by (for) aural populations.The findings of this study were limited to the described sample, conditions, time frame and measurement instrument. However, from the 75.6% positive response to the clinical questions it was inferred that the overall outcome of the study was positive. Future research might affirm the appropriateness of autohypnotic relaxation therapy as a possible service to the deaf consumer of psychological counseling.

This is the first known occupational therapy (OT) study to examine the emergent patterns of the client-therapist working alliance during the course of a community-based OT intervention. The experiences of both the adult client and OT in each of four dyads are explored and described as they relate to the evolution of the alliance over time and the impacting contextual factors. These experiences were considered alongside the therapy outcomes. Mixed methods, including quantitative scales and interviews, were used in this multiple-case study situated within a pragmatism paradigm. Individual case and cross case analyses were conducted leading to the identification of eleven cross case themes. These findings suggest that the interpersonal relationship between a client and OT develops with the goal of becoming a safe harbour for the clients. The strengthening interpersonal bond appears to create an impetus within the client to engage in therapeutic activities. This enticed engagement results in the client’s performance of novel activity purposefully selected by the OT as bearing personal meaning for the client. The clients’ engagement often results in enhanced insight into their abilities and meaningful functional gains. This success appears to reinforce and energize both the momentum toward the collaboratively-established therapy goals, as well as provides a positive feedback mechanism into the working alliance. The OT’s training, philosophy and skill, client’s attributes, and environmental influences (both physical and social) all appear to have potential implications upon the working alliance’s development and/or the therapeutic achievements. Further research will be needed to confirm or disconfirm these findings and may include further study with variable client populations (e.g., different ages, different conditions), the role of humour in the therapeutic process, the impact of client’s degree of social isolation on the alliance, as well therapists’ disparate levels of use-of-self and the related impacts upon the alliance.

Therapeutic landscapes are places that contribute positively to a healing experience or to the maintenance of an individual's health and wellbeing. The literature on therapeutic landscapes has been growing steadily since the early 1990s, but researchers have yet to sufficiently explore both non-Western and gendered perspectives. The research presented in this thesis addresses these two gaps by examining how Kaqchikel men and women in the municipality of San Lucas Tolimán, Guatemala, differ in their construction and use of the therapeutic landscapes that surround them in their daily lives. <br /><br /> This research is broadly informed by feminist thought and methodologies, and the specific strategy of reflexivity was employed throughout the research process. In terms of gathering data, the two specific methods used were photovoice and structured interviews. Photovoice, it is argued, is an ideal method for studying therapeutic landscapes (particularly in a cross-cultural setting) because it gives participants the opportunity to reflect on their therapeutic landscapes before explaining them. The photographs also act as a visual cue that enhances interviews and can also bridge different experiences of reality. In total, 28 key informants were recruited through snowball sampling, with an equal number of male and female participants. Issues of foreign language research and translation are also addressed and some strategies for dealing with working in a foreign language are suggested. <br /><br /> Four main themes emerged from the data, and these themes revealed that Kaqchikel therapeutic landscapes are heavily driven by the poverty and violence experienced by the majority of participants. These four themes were: daily survival, community development, 'escape', and negative landscapes. Through these themes it was shown that the therapeutic landscapes of the Kaqchikel differ greatly between men and women due to traditional gender roles and relationships as well as the disproportional effect of violence on women, which restricts their mobility and ability to access their therapeutic landscapes. Finally, these themes reveal that Kaqchikel therapeutic landscapes span multiple generations and are multilayered, highly dynamic, and contingent on the social, political, and economic climates of the day.

Therapeutic landscapes are places that contribute positively to a healing experience or to the maintenance of an individual's health and wellbeing. The literature on therapeutic landscapes has been growing steadily since the early 1990s, but researchers have yet to sufficiently explore both non-Western and gendered perspectives. The research presented in this thesis addresses these two gaps by examining how Kaqchikel men and women in the municipality of San Lucas Tolimán, Guatemala, differ in their construction and use of the therapeutic landscapes that surround them in their daily lives. <br /><br /> This research is broadly informed by feminist thought and methodologies, and the specific strategy of reflexivity was employed throughout the research process. In terms of gathering data, the two specific methods used were photovoice and structured interviews. Photovoice, it is argued, is an ideal method for studying therapeutic landscapes (particularly in a cross-cultural setting) because it gives participants the opportunity to reflect on their therapeutic landscapes before explaining them. The photographs also act as a visual cue that enhances interviews and can also bridge different experiences of reality. In total, 28 key informants were recruited through snowball sampling, with an equal number of male and female participants. Issues of foreign language research and translation are also addressed and some strategies for dealing with working in a foreign language are suggested. <br /><br /> Four main themes emerged from the data, and these themes revealed that Kaqchikel therapeutic landscapes are heavily driven by the poverty and violence experienced by the majority of participants. These four themes were: daily survival, community development, 'escape', and negative landscapes. Through these themes it was shown that the therapeutic landscapes of the Kaqchikel differ greatly between men and women due to traditional gender roles and relationships as well as the disproportional effect of violence on women, which restricts their mobility and ability to access their therapeutic landscapes. Finally, these themes reveal that Kaqchikel therapeutic landscapes span multiple generations and are multilayered, highly dynamic, and contingent on the social, political, and economic climates of the day.

The working alliance has received consistent empirical support relating the construct to psychotherapy outcome. There is no empirical research on any particular techniques that may prove useful at increasing the level of working alliance. In this study, the therapeutic compliment is defined, discussed, and compared with other therapeutic interventions to find its usefulness in therapy and its ability to impact the working alliance. 120 African-Americans from a large southwestern university and a medium southeastern university participated in this study by viewing one of six mock therapy sessions that had one of three different interventions: Therapeutic Compliment, Simple Compliment, and Advanced Accurate Empathy. The mock sessions were created to provide two levels of session relationship (high and low). The participants completed three measures, the Working Alliance Inventory, Hopefulness Scale, and Accurate Empathy Scale, to determine the perceptions of the different interventions. The study utilized multiple analyses of variances (ANOVAs) to compare the means of the three interventions.Statistical significance was not found with overall general working alliance scores from the Working Alliance Inventory (WAI). The individual subscales of the WAI, goals, tasks, and bonds, however; did reveal significance when comparing the interventions across one level of the session relationship (high). The interventions were not statistically different from each other in terms of perceived hopefulness and empathy. No significance was found when comparing the interventions with perceived hopefulness of outcome or level of perceived empathy. The implications from this study include a first look at the use of complimenting in therapy and a first attempt to analyze a specific technique to create an influence on the working alliance. Further research is still needed to understand which techniques are more beneficial at creating an affect on the working alliance.

The purpose of this study was to examine the use and effect of figurative language discourse in examples of expert therapy. More specifically, one of the main reasons for conducting this study was to describe figurative language discourse, its production, use, and potential effects on the therapeutic relationship and client experiencing. Training videos were selected and transcribed using criteria for selection of examples of expert therapy. Fifty-six excerpts, each two-minutes in length, were taken from the transcribed therapy sessions and used for the analyses. One set of raters was trained to identify instances of figurative language and make ratings of shared theme. Another set of raters was trained to use the Experiencing Scales and the Working Alliance Inventory on the transcribed excerpts. Analyses were conducted to investigate the frequency of use and relationship between therapist and client figurative language dialogue. Results indicated that the majority of figurative language used in examples of expert therapy is metaphoric in nature. Additionally, it was found that the majority of figures of speech were frozen in meaning or were commonly used. A small percentage of figures of speech were shared conceptually between the therapist and the client. Regarding the shared figurative language, a statistically significant difference between therapists and clients with regard to their production of shared figurative language was found and indicates that use of shared figurative language by expert therapists may be a subtle and indirect way in which therapeutic alliance is initially established as well as maintained. It may also represent how expert therapists follow content of the therapy session. In addition, a regression analysis conducted to determine if there is a relationship between shared figurative language and ratings of therapeutic alliance did not meet statistical significance. Overall, the results of this study provide preliminary findings with regard to what type of figures of speech expert therapists use and give a clear direction in terms of the next direction for research. Additionally, this experiment provides direction for the type of methodology that should be utilized in future research.

Abstract Traditionally, doctors and patients are based on different cognitions and ways of thinking to communicate with each other. Doctors are often holding dominated role in the process. The knowledge of doctors is coming from the curricula that they have learned at medical school and their clinical experience, whereas the knowledge of patients is coming from their health experience and the information which was reported in the common medical magazines and journals. Because of the different cognitive modes of medicine between doctors and patients, the efficiency of doctor-patient communication is usually unsatisfied. With the popularity of medical information, the rise of consumers¡¦ consciousness, and the change of health insurance system, patients are asking better quality of medical treatment now. Thus, the quality of doctor-patient communication seems to be more important. This research was employed by case study. The doctors and outpatients of the pediatrics department were selected as the research sample. Totally, the sample included six senior doctors with three different levels of hospital and 30 outpatients. The dialogs of interrogation enquiry between these doctors and patients were collected. The analytic framework was derived from Brown and Levinson¡¦s politeness theory, Grice¡¦s conversational maxims, and Roter¡¦s analytical system of doctor-patient communication behavior. This study analyzed the politeness strategies used during doctor-patient communication, and also found the communication modes that were frequently emerging in the diagnostic processes. The research results show that the maximum politeness strategies used in pediatrics clinics is the bald on record. This reveals a kind of consensus on the importance of communication efficiency for doctors and patients. Most of patients adopt more polite strategies to communicate with doctors for medical knowledge. The results also suggest several commonly-seen dialog modes providing the further self-awareness and self-observation for doctors and patients. Indirect communication, the off-record politeness strategies are also appeared in the dialogues of doctors and patients. This study contributed toward gaining the efficiency of doctor-patient communication, thus may be helpful in the saving of medical resources. Keywords: doctor-patient communication, politeness theory, therapeutic behavior, pediatrics clinics

Thesis (Ph. D.)--Mississippi State University. Department of Political Science and Public Administration. / Title from title screen. Includes bibliographical references.