The Impact of Therapist Ability to Perceive Displayed and Hidden Client Reactions on Immediate Outcome in First Sessions of Brief Therapy

In this replication/extension of Thompson and Hill (1991), we examined therapist ability to perceive displayed and hidden client reactions. During videotape reviews of 29 first sessions of six-session therapy with graduate student therapists and volunteer clients, clients reported displayed and hidden reactions to therapist interventions while therapists reported reactions they thought clients were displaying, hiding, or unaware of. If therapists identified the same reaction cluster as clients did for a given therapist intervention, a match was counted. Results indicated that: (1) Therapists were better than chance at matching supported reactions, no better than chance at matching challenged and no reaction, and worse than chance at matching on therapeutic work and negative reactions; (2) Clients hid more negative reactions than any other type of reactions; (3) Therapists were aware that clients were hiding and unaware of negative reactions, but they were not as accurate at identifying hidden reactions as they were at identifying displayed reactions; and (4) When therapists matched on negative reactions, they were less helpful in the subsequent intervention. Results are discussed in terms of implications for practice and further research.