The purpose of this study was to investigate the use and perceived effects of immediacy in 16 cases of open-ended psychodynamic psychotherapy. Of 234 immediacy events, most were initiated by therapists and involved exploration of unexpressed or covert feelings. Immediacy occurred during approximately 5% of time in therapy. Clients indicated in post-therapy interviews that they remembered and profited from immediacy, with the most typical observed consequences being clients expressing feelings about the therapist/therapy and opening up/gaining insight. Amount of immediacy was associated with therapists' but not clients' ratings of session process and outcome. Therapists focused more on feelings and less on ruptures, and initiated immediacy more often with fearfully than with securely attached clients. Implications for practice, training, and research are offered.

This study sought to assess the association of client- and therapist-rated real relationship with each other and with the outcome of brief psychotherapy. It also aimed to determine whether changes over time in perceptions of the real relationship and increasing convergence between clients' and therapists' ratings of the real relationship were associated with outcome. Forty-two clients and their therapists (n = 19) at 2 university counseling centers completed measures assessing the strength of their real relationship after every session of brief psychotherapy. They also completed an outcome measure at the end of treatment. Clients' ratings of the real relationship after the first session, first quarter of treatment, and after all sessions combined related to outcomes. Therapists' ratings of the real relationship at these time points did not relate to outcome. However, increases over time in therapists' ratings of real relationship strength, as well as increasing convergence with clients' ratings of the real relationship, did relate to outcome. Implications for future research and practice are discussed.

The relationship between treatment progress (as rated by both clients and therapists) and real relationship (also rated by both clients and therapists) was decomposed into between-therapist and within-therapist (between-client) effects and analyzed using the actor-partner interdependence model. We reanalyzed a subset of the data, 12 therapists and 32 clients, from Gelso et al.'s (2012) study of brief, theoretically diverse outpatient treatment. Consistent with and extending previous research, clients whose therapists provided higher average levels of client-perceived real relationship across the clients treated by a given therapist had better progress ratings from both themselves and their therapists. Within each therapist's caseload, differences between clients in client- or therapist-rated real relationship were unrelated to either client- or therapist-rated outcome. Clients whose therapists provided higher average levels of therapist-perceived real relationship, across the clients treated by the therapist, had worse progress ratings from the therapists. The results provide additional evidence for the importance of between-therapist differences in therapeutic relationship qualities, both client and therapist rated.

After they learned exploration skills, 103 undergraduate helping skills students were taught to use challenges. Prior to training, students' selfefficacy for using challenges did not change, although the quality of written challenges and reflections of feelings did. After training, students rated themselves as having more self-efficacy for using challenges and were judged as providing better written challenges, although there were no further changes in quality of written reflections of feelings. Students maintained self-efficacy for using challenges at a 5-week follow-up. Self-efficacy for using challenges increased after lecture, modeling, written practice, and lab group practice, but students indicated that practice was the most helpful training component. Natural helping ability predicted higher final levels of self-efficacy for using challenges. Qualitative results indicated that cultural background played a role in learning and using challenges.

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