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Objective: The authors' aim was to evaluate patient-provider relationships in a college health center. Participants: Eighty student patients and their health-care providers. Methods: Patients completed a measure of perceived health competence before a consultation and measures of provider participatory behavior and interpersonal behavior before and after the consultation. They evaluated their satisfaction with care and compliance after the consultation and again 2 weeks later. Providers completed measures of their participatory behavior and patients' interpersonal behavior after the consultation. Results: Patients preferred to be well informed and to have their preferences taken into account, and generally felt competent at managing their own health affairs. They indicated they obtained the high level of participation they desired. Patients desired and actually experienced friendly and submissive providers. Degree of match between patients' desired and actual level of involvement in their care was associated with greater satisfaction. A greater match between the extent to which they desired the provider to be affiliative and the provider's actual affiliative behavior was associated with more satisfaction. No variables were predictive of patient compliance. Conclusion: The authors discuss results in terms of the influence of situational factors characteristic of a college health center. [ABSTRACT FROM AUTHOR]

This study evaluated the effects of giving patients treatment-relevant choices, and the influence of provider-patient interpersonal behaviors, on patients' adjustment to and satisfaction with a protracted healthcare procedure. 102 patients receiving complete dentures were randomly assigned to a Decisional Control group, a No-Decisional Control group, or to a Treatment as Usual Control group. No main effects for the 'control' manipulations were obtained, and interactions obtained between control conditions and patient dispositional differences in locus of control were not consistent with earlier findings. Dentists' and patients' interpersonal appraisals of each other, as measured by the Impact Message Inventory, were the most significant factors accounting for patient outcome differences. Consistent with previous research, the experience of oppressive interpersonal impacts both by patients (physician low friendliness) and dentists (patient low friendliness, high dominance, high hostility) were associated with poorer patient outcomes. [ABSTRACT FROM AUTHOR]

Desire for healthcare control, health locus of control, perceived control over diabetes, satisfaction with diabetes treatment, and general personality traits were assessed in 54 Type 1 and Type 2 diabetic patients of the same male endocrinologist during a regularly scheduled office visit. At the end of the consultation, both patients and the physician completed a measure describing the interpersonal impacts produced in each by the other's control and affiliation behaviors. Patient success at diabetes control was assessed via glycosylated hemoglobin A1C (HA1C) level on the day of the visit and variability in HA1C levels across several visits. Patients' satisfaction with treatment was unrelated to diabetes control measures. Patients' desire for behavioral involvement in their own healthcare and NEO Agreeableness scores were positively associated with diabetes control. Better diabetes control also resulted when the physician perceived patients to be more controlling and less submissive, and when there was more reciprocity in patient and physician's perceptions of the other's controlling interpersonal behavior. Findings support the conclusion that both a patient's self-reported desire for involvement in his or her healthcare and the transactional fit of patient-physician interpersonal behaviors are potentially important contributors to better diabetes outcomes. [ABSTRACT FROM AUTHOR]

In 1983, a group of 14 prominent psychotherapy process researchers attended a workshop sponsored by the US National Institute of Mental Health. Although the previous decade had seen a marked emphasis on psychotherapy outcome research, there had also been several major advances in the field of process research. The goals of the workshop were to review the current state of the field, address methodological and conceptual issues, and provide recommendations to advance scholarship in this area. In this paper, we summarize the major themes of the workshop and consider the degree to which its recommendations have come to fruition via subsequent developments in the field. Although 30 years have passed since the workshop was held, its insights remain highly relevant to psychotherapy process research today.

Purpose: This study evaluated symptoms of acute stress disorder (ASD), satisfaction with appearance postsurgery, and satisfaction with care in patients with maxillofacial injury at their first postsurgical physician visit. To determine the best predictors of patients' ASD symptoms and satisfaction, data also were obtained on the patients' strategies for coping with the stress of the injury, on the patients' and doctors' interpersonal appraisals of each other, and on the doctors' participatory behavior during the visits., Patients and Methods: A total of 47 patients who had sustained traumatic maxillofacial injury requiring emergency medical/surgical treatment were administered self-report measures immediately before and after their first postsurgical visit 10 to 12 days after trauma exposure. Doctors completed self-report measures after the visit and evaluated the patients' severity of injury., Results: Patients experienced high levels of ASD in the short-term period after surgery. Use of emotion-focused strategies by patients to cope with stress was associated with more ASD symptoms but better satisfaction with facial appearance. The more severely injured patients were less satisfied with their appearance and were viewed by their doctors as being more interpersonally controlling during the postsurgical visit., Conclusions: Closer attention by doctors to patients' interpersonal behavior may aid in early identification of those patients with maxillofacial injury who may experience longer-term social problems related to their altered facial appearance.

Objective: A comprehensive review was conducted of the theoretical and empirical work that addresses the preference-match strategy in physician-patient communication., Methods: Searches were conducted on Medline, PsychINFO, InFoTrac One File Plus, Sociological Abstracts, and Dissertation Abstracts through 2004. The following keywords were used: patient preferred and received information; patient preferred and actualized treatment decision-making; patient-physician beliefs in shared decision-making; patient-physician match, fit, or concordance; reciprocal relationship or mutuality; doctor-patient affiliation, control, relationship; match/fit between patient and physician in affiliation, control, or relationship., Results: Findings revealed varying degrees of support for the positive effects of matching patients' preferred levels of information, decisional control, and consultative interpersonal behavior., Conclusions: Findings justify not only continued but expanded research efforts in this area that would incorporate recommended changes in research design and implementation. PRACTICE AND RESEARCH IMPLICATIONS: Assessment strategies and match interventions are discussed that, if evidence continues to be supportive, might routinely optimize patient-physician encounters toward more positive outcomes. Methodological guidelines are suggested that can improve future preference-match studies of the patient-physician interaction. Practitioners need to consider adoption of patient-match assessment and intervention strategies in addition to recent exclusive concentrations on patient-centered and shared decision-making approaches.

Background: Families of critical care patients experience high levels of emotional distress. Access to information about patients' medical conditions and quality relationships with healthcare staff are high-priority needs for these families., Objectives: To assess satisfaction with needs met, signs and symptoms of acute stress disorder, interpersonal perception of healthcare staff, level of optimism, and the relationships among these variables in patients' family members., Methods: Family representatives of 40 patients were administered a brief version of the Critical Care Family Needs Inventory, the Acute Stress Disorder Scale, the Brief Symptom Inventory, the Impact Message Inventory, and the Life Orientation Test shortly after admission of the patients to the intensive care unit and after discharge., Results: Levels of dissociative symptoms associated with acute stress disorder were elevated in family members just after admission but decreased significantly after discharge. Needs the families thought were least satisfactorily cared for after admission involved lack of information. Interpersonally, attending physicians were viewed as more controlling than bedside nurses at admission; nurses were viewed as more affiliative than physicians both at admission and after discharge. At admission, higher optimism of the family members was strongly related to greater satisfaction with needs met, to perceptions of affiliation from physicians, and to perceptions of not being controlled by physicians., Conclusions: More interpersonal contact with medical staff can help meet the information needs of patients' families. Nurses may aid in families' adjustment by fostering a sense of optimism in family members and encouraging them to participate in the patients' care.

Following a brief overview and commentary on the physician-patient communication literature, this article summarizes and evaluates research on the relationship between physician-patient control (dominant-submissive) and affiliation (friendly hostile) behaviors as they relate to medical outcomes. Findings for both verbal and nonverbal control and affiliation measures are included. The interpersonal circumplex (together with the important interactional principles that it incorporates) is then introduced as an heuristic guide for future medical interaction research. The circumplex was constructed as a conceptual and empirical model to integrate the numerous studies that have established control and affiliation as universal dimensions of human interpersonal behavior and relationships. Next, the small group of studies that have applied circumplex inventories to analyses of practitioner-patient transactions are reviewed with emphasis on their strengths and unique aspects of their findings. The concluding section enumerates advantages and innovations that the interpersonal circumplex and its measures can provide to facilitate more heuristic studies of physician-patient interactions.

This article discusses resistance in psychotherapy using the contemporary interpersonal communication model of psychotherapy. This perspective defines resistance as moments during sessions when the patient and therapist are interacting with one another in such a way that the patient is kept from becoming aware of any covert experiences or transactional patterns that are conflictual and anxiety provoking. The ways in which resistance may be conceptualized and worked with are discussed and applied to three patient vignettes, with an emphasis on working with resistances as they are manifested in the patient-therapist relationship. Some of the potential reactions of the therapist to resistance are discussed, including some relatively beneficial and some problematic instances., (Copyright 2002 John Wiley & Sons, Inc.)

Throughout this issue on countertransference (CT) and elsewhere, the multiple terms used to describe CT events provide rich conceptual diversity, but also result in theoretical isolation and clinical compartmentalization. Our study and understanding of CT would benefit remarkably if we could agree on empirical-therapist features that any CT conceptualization must target. Subsequent discussions of CT then could specify which of the respective empirical features are being addressed. Accordingly, I offer a descriptive framework that asserts that CT and its hypothesized subtypes (e.g., subjective and objective) can be detected empirically whenever a therapist's experiences and actions with a particular client assume one of several definable "deviations from baseline." If, in our clinical or research pursuits, we are to understand CT, we have to take the time to assess the necessary behavioral baselines for therapists and their clients.

This contribution to the special issue reviews my theoretical and research journey into contemporary interpersonal theory and research. A seminal period involved conceptualization of a "communications" approach to psychotherapy and culminated in development of the Impact Message Inventory (IMI). Generation of the IMI necessitated immersion within the interpersonal circumplex measurement tradition and resulted in an "interpersonal communication" theory, combining concepts from both traditions, which appeared initially in the Handbook of Interpersonal Psychotherapy (Anchin & Kiesler, 1982). Subsequent research has concentrated on circumplex refinement of both the IMI and a second inventory, the Check List of Interpersonal Transactions, which was derived directly from the Interpersonal Circle. A continuing theme is the notion that precise and replicable tests of contemporary interpersonal theory, especially of interpersonal complementarity, require circle inventories that possess ideal psychometric and circumplex properties.

Contemporary interpersonal theory uses 2 models to represent the process and content of interpersonal transactions. The interpersonal transaction cycle is a dynamic model demonstrating the interaction between the overt behaviors and the covert intrapsychic experiences of 2 interacting individuals in action-reaction event chains. The interpersonal circle is a static model codifying individual differences across various interpersonal content domains (e.g., traits, acts, problems, impacts). The present study used 150 pairs of undergraduates to demonstrate cross-observer structural convergence of 2 separate interpersonal circumplex inventories measuring the "action" and "reaction" components of the transaction cycle, providing evidence that both components of the cycle can be captured by existing circumplex measures, and allowing researchers to proceed on to more comprehensive tests of interpersonal theory.

The present study provides empirical support for a new interpersonal concept of transactional escalation. This proposition hypothesizes that an individual's typical pattern of interpersonal behaviour will become more extreme and rigid under stressful interpersonal conditions. Thirty Caucasian females participated in brief interviews that had two stages: low-stress and high-stress conditions. The half of the subjects who were assigned to a high-stress interview condition were predicted to show an escalation of their typical friendly-submissive patterns during the second half of the interview. Findings revealed that escalation was evidenced by an increase in the extremeness and rigidity of their interpersonal behaviour. Implications for interpersonal theory, and for diagnostic and psychotherapy endeavours are discussed and directions for future research are provided.

The present study used ratings of patients' interpersonal behaviors by groups of clinical trainees and undergraduates to test a priori classifications of DSM-III personality disorders onto the 1982 Interpersonal Circle. A sample of 8 videotaped personality disorder patient interviews were obtained from two psychiatric training tape series. A panel of 10 diagnosticians provided independent checks on the diagnosis assigned to the 8 patients by the training series and also rated the degree of prototypicality each case exhibited. Interpersonal characterizations of the interview behavior of the 8 patients were obtained from ratings of the tapes by undergraduate and clinical trainee observers. Findings revealed that interpersonal inventory ratings significantly differentiated the overt interpersonal behavior of the 8 patients, although the obtained interpersonal profiles appeared more complex and subtle than previous interpersonal translations suggest.

In psychotherapy theorty, research, and practice, relationship has remained a controversial and elusive construct. Psychoanalytic theorists highlight transference-countertransference factors as central theoretical and technical components, but have yet to translate these constructs into a scientifically useful format. Rogerian theorists have consistently specified the relationship factors of positive regard, empathy, and congruence as "necessary and sufficient conditions" for constructive personality change in therapy and have evolved operational anchorings (e.g. Rogers, Gendlin, Kiesler, and Truax, 1967). Behaviorists (e.g., Wilson and Evans, 1978) conceptualize relationship factors as nonspecific variables which are important in enhancing the social influence and eliciting power of the therapist as an agent of change, while considering most client emotional responses toward the therapist as random factors which are generally irrelevant to the therapeutic process. My purpose in this paper is to offer a conceptual and empirical analysis of relationship in human behavior and in psychotherapy from an interpersonal communication perspective.