Researchers and clinicians report that they think the client is the most influential component in determining the outcome of therapy. Although a variety of studies have examined the impact of various client factors on the outcome of couple therapy, this research is not cohesive and produces inconsistent results. The purpose of this multi-method study is to present a sense of the range and depth of client factors that influence the outcome of couple therapy. The use of qualitative and quantitative methods allowed the data to build on existing research while expanding the range of client factors considered. Data were gathered using a dynamic, web-based survey which assigned participants to discuss a case of successful or unsuccessful couple therapy. Participants provided their own descriptions of influential client characteristics. Participants also rated how important they thought several literature-based client factors were. Quantitative data analysis utilized descriptive statistics, principal components analysis, and logistic regression. Qualitative data were analyzed in two stages, using content analysis. Results indicated that couples can be conceptualized by five arenas of couple focus; these arenas accurately predicted whether participants were discussing a successful or unsuccessful case of couple therapy 85.9% of the time. Regarding individual client characteristics, in general, clients whose couple therapy was successful tended to be open to each other and committed to the relationship and to therapy. Unsuccessful couple therapy tended to focus on a greater number of individual issues. Couple dynamics characteristics differed according to outcome groups; participants described four types of couple dynamics that influenced couple therapy to be unsuccessful. Data showed that many client factors influenced the outcome of couple therapy, and that uncommon client characteristics could be vital to the outcome of some cases. Participants described a client's life events as impacting the outcome of couple therapy by increasing one person's vulnerability to his or her partner. If the partner acted in a way that created a sense of connection or support, this contributed to successful couple therapy. The results are presented in connection to previous research, when possible. Finally, implications for theory, research, and clinical work with couples are discussed. / Ph. D.

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Client outcomes in psychology training clinics have been shown to be generally worse than other outpatient settings. Although this finding has been repeatedly demonstrated, no consensus of cause has emerged in the literature. One possible explanation of such findings may relate to psychotherapist effects, a historically neglected variable that has received increased attention in more recent literature. Among psychotherapist effects researched, competency has emerged as a compelling factor worthy of more research. Given that most growth in competence occurs during graduate training, investigating the relationship between competency and client outcome offers great potential benefit for informing optimal training, nature of client symptom improvement, and a more accurate depiction of differences in psychotherapist effects across training and non-training settings. The purpose of this study was to explore the trajectory of competence development during doctoral training in health services psychology and to investigate the association of trainee competency to the psychotherapy outcomes evidenced by their clients. Practicum evaluations of 36 trainees and outcome data (using the Outcome Questionnaire-45.2) from 244 adult clients were included in analyses. Results of the study suggest there is a positive relationship between cumulative semesters of training and competency scores (rs[118]= .34, p < .001). Notably, there was no significant difference in psychotherapy outcome between low and high trainee competence. The results of the current study, relevant literature and limitations are discussed. Suggestions for future research are proposed.

Evidence suggests that Video Interaction Guidance (VIG) is an effective intervention leading to positive behaviour change when used with parents and their children. The aim of this paper is to explore the processes of Video Interaction Guidance (VIG). Utilising a case study methodology it explores some of the key processes within the video intervention through in-depth analysis of shared review sessions. It also examines what parents and EPs perceive as significant and helpful within the process of VIG. Results reveal that the interplay between the visual image and the nature and content of discussions appears to be qualitatively different when parents are more actively engaged in video review sessions. Parents perceived the intervention in different ways, which appeared to correspond with their level of engagement in shared review sessions. The limitations of the study and suggestions for future research are discussed and the direct implications are dealt with in the overall conclusion in Paper 2 (pg. 93). Abstract Evidence suggests that Video Interaction Guidance (VIG) is an effective intervention that leads to positive behaviour change when used with parents and their children. This paper aims to evaluate the perceived impact of VIG when used with four parents and their children. Utilising a mixed methods case study methodology, it explores parents’ views of their experiences of the video intervention and examines whether any changes are maintained over time. Findings indicate that parents perceived some positive attitudinal and emotional changes. However, it was not clear that any changes were maintained over time and whether they could be solely attributed to the impact of VIG but were perhaps a result of a combination of other factors. A number of common themes emerged across cases that related to barriers and enablers of successful outcomes in VIG as perceived by parents and EPs. The direct implications of this study, suggestions for further research, and for Educational Psychology are discussed.