Identity Negotiation in Psychotherapy: The Influence of Diagnostic and Rapport-building Strategies on the Effects of Clinical Expectations

Abstract

In therapy, the expectations or hypotheses that therapists have of their clients, and the therapeutic strategies they employ with them, could influence identity negotiation processes. In the current study, 38 postgraduate therapist trainees interacted with 72 undergraduate clients in audiotaped counseling sessions. Therapists were led to expect that their clients were depressed or were given no expectation, and were asked to employ either diagnosis or rapport building with their clients. Therapists with expectations of client depression elicited similar levels of depressed behavior in their clients during diagnosis and rapport building as well as when they had no expectation and diagnosed their clients. Therapists focused on rapport building without an expectation elicited significantly less depressed behavior from their clients. Both applied and theoretical implications are discussed.

Keywords:

• Self-fulfilling prophecies
• Self-verification
• Diagnosis
• Rapport-building
• Therapy

This research was supported by a grant from the Australian Research Council to Art Stukas. This research was conducted as part of Jonathan Tandos's doctoral thesis, submitted to La Trobe University.

We thank Jennifer Boldero, Marc Kiviniemi, and Stephanie Madon for their comments on the thesis and Anthony Lyons, Mark Snyder, and the Social Psychology Unit at La Trobe University for their support and counsel. Three anonymous reviewers and the editor offered feedback that improved this article.

Notes

1. Although empathy and rapport are not identical conceptually, they can be seen as serving a similar function, if one accepts empathy generation as the therapeutic skill of communicating understanding to a client (Deutsch & Maddle, 1975; Egan, 1998), which deepens a therapist's harmonious and engaging connection with a client, and therefore advances the generation of rapport.

2. The assessment of clients as non-depressed is confined to the completion of our Depression Questionnaire by clients prior to the interaction only; this instrument should not be considered as offering diagnoses of depression such as could be indicated by a suitable diagnostic instrument such as the BDI-II (Beck et al., 1996) or by clinical judgment.

3. Although objective coding of therapist behavior would provide a more exact check on their strategy use, we are confident that our within-therapist manipulation of strategy across two interactions further encouraged therapists to differentiate their approaches with clients.

4. The pattern of results is essentially the same when we treat our data as non-independent (with therapist strategy as a repeated measure), however the complexity of the analyses makes for a less-clear presentation.