Psychotherapy 2016 American Psychological Association

2016, Vol. 53, No. 3, 302307 0033-3204/16/$12.00 http://dx.doi.org/10.1037/pst0000089

When Countertransference Reactions Go Unexamined Due to

Predetermined Clinical Tasks: How Fear of Love Can
Keep Us From Listening
Shweta Sharma and J. Christopher Fowler
Baylor College of Medicine

The psychotherapeutic work is characterized by processes that are involved in the development of the alliance,
as well as processes that lead to the ruptures in the alliance (error) and its repair. The purpose of this article
is to highlight the clinical error that occurs when a clinician fails to adequately respond to a patients emotional
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

signals due to countertransference reactions that results in an overemphasis on predetermined tasks the
This document is copyrighted by the American Psychological Association or one of its allied publishers.

clinician naturally deems as necessary. A clinical vignette is presented to illustrate the error and 3 alternative
approaches to the error are discussed. These include(a) shared decision-making, (b) addressing and
repairing alliance rupture, and (c) management of countertransference. Brief theoretical and clinical context
for each alternative approach is provided.

Keywords: alliance rupture, countertransference, decision-making, psychotherapist errors, psychotherapy

relationship

Psychotherapeutic work is generated in the affective relational
bond between the patient and the clinician. To enter a relationship is
to enter into an unknown, even as the patient and the clinician
collaborate on the tasks and goals of treatment. Psychotherapeutic
encounters require careful attention to the presence of explicit and
implicit tasks, and the extent to which the patient and the clinician are
able to maintain a strong relational bond or working alliance. A source
of potential clinical error occurs when the clinician fails to adequately
respond to a patients emotional signals due to predetermined and
pressing therapeutic task (Fowler & Perry, 2005; Searles, 1967). At
times, predetermined tasks can conceal implicit motivations that can
unknowingly add to their press. Implicit motivations are ubiquitous in
human interactions and psychotherapeutic interactions are no excep-
tions; however, when a clinicians press to get work done via
preordained tasks is intricately intertwined with and embedded within
their countertransference reactions, the interaction can continue un-
examined and deteriorate into a power struggle.
Most would agree with the supposition that effective psychother-
apeutic work requires a stance of ongoing self-awareness of subjec-
tive reactions as a vital source of information in order to remain
affectively attuned to the subtle interpersonal shifts that occur in the
course of an encounter and the treatment. We are here concerned with
examining the emphasis on explicit, overt, conscious therapeutic tasks
that are part of each encounter and how these can negatively impact
the therapeutic process. We may not appreciate that an overemphasis
on the immediate, explicit, and predetermined tasks of psychotherapy
may be potentially hiding the countertransference elements. When a
Shweta Sharma and J. Christopher Fowler, Menninger Department of
Psychiatry and Behavioral Medicine, Baylor College of Medicine.
Correspondence concerning this article should be addressed to Shweta
Sharma, Menninger Department of Psychiatry and Behavioral Medicine, Bay-
lor College of Medicine, 12301 Main Street, Houston, TX 77035. E-mail:
ssharma@menninger.edu
clinician enters the unknown of an interaction with a patient, with a set
task or agenda, it has the potential to constrain the way in which they
listen to what is emerging in the encounter and the emphasis they
place on exploring and interpreting transference and countertransfer-
ence reactions. The clinicians excessive adherence to tasks or prede-
termined agenda can have a number of implications, including taking
them away from being open to discerning in the here-and-now, the
influences on their understanding that stem both from their transfer-
ences and the emotional responses to the patients transferences.
Furthermore, if the clinician is uncomfortable or avoidant of aspects
of the patients cyclical relational patterns and their own emotional
response, then the therapeutic task can provide easy rationalization for
the clinician to focus on explicit tasks of a treatment plan.
In this article, we will begin by providing a clinical example
illustrating the clinical error that occurred when in a countertransfer-
ence enactment that resulted in overemphasis on the predetermined
psychotherapeutic task, the clinician (the first author) failed to ade-
quately respond to the patients emotional signals. We will then
discuss three alternative approaches to the error including(a) shared
decision-making, (b) addressing and repairing alliance rupture, and (c)
management of countertransference, as well as the theoretical and
clinical context for our choice of them.
Why Do You Ask if You Are Not Going to Listen: A
Clinical Vignette
I (first author) am a psychologist on a multidisciplinary team
providing intensive hospital-based treatment for young adults.
During a busy and intense week, I felt preoccupied with one of my
patients, Jenny1a highly intelligent and verbally nimble young
woman who presented for hospital treatment due to the worsening
1
The patients name and other identifying information have been
changed.

302
 THERAPEUTIC LISTENING
symptoms of depression and anxiety that made it impossible for
her to function at school and in relationships. I experienced deal-
ings with Jenny as extremely challenging and exhausting, an
experience shared among the other members of the staff. The main
dynamic seemed to be that of her feeling under attack, or attacking
the staff. To my extreme frustration, I found myself pulled into this
dynamic. Encounters with her left me feeling disappointed, de-
feated, and defensive. I experienced her as needy but extremely
difficult to comfort and satisfy. Her response to my attempts to
help felt rejecting and brought up feelings of inadequacy and
incompetence, which I countered by irritation and impatience
toward her, instead of acknowledging my limits. She felt unheard
and demanded more time and attention. I tended to withdraw in
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order to escape her (demands) and she experienced me as depriv-
This document is copyrighted by the American Psychological Association or one of its allied publishers.
ing. Faced with the mounting feeling of being defeated and failing
Jenny, I turned to my colleagues, but remained unable to success-
fully navigate the cyclical relational pattern playing out between
the two of us. Slowly and gradually, I began to feel wary of Jenny
and started to avoid interacting with her outside of the scheduled
meetings.
One day I had a particularly intense interaction with Jenny. I had
scheduled a meeting with her to review the findings from the
psychological testing we had completed together. The following is
a construction of the exchange we had on our way to my office.
Clinician: How should we do this? What would be helpful?
Jenny: [shrugs her shoulders]
Clinician: I could share my observations from the test data
and you could tell me what resonates with you
and what doesnt and think out loud with me?
Jenny: Thats fine.
Clinician: I would like this to be helpful to you. I understand
that you did not learn anything from the previous
testing.
Jenny: Thats not true. It was helpful [looks upset and
irritated].
Clinician: Well, thats what you said to me when we talked
[irritated and defensive].
Jenny: Okay [looks angry]!
Jenny had taken immediate offense to my comment about pre-
vious testing experience. I was not conscious of it in the moment;
however, in retrospect, I was repeating Jennys relational pattern.
In Jennys internal world, every interpersonal interaction was like
a battle in which she had to have her argument ready for the fight.
Similar to Jenny, I was dealing with my anxiety about giving
potentially difficult feedback to her and was building my argument
or defense, anticipating an attack from her. By the time we got to
my office Jenny was angry and I felt nervous and frustrated to find
myself in this all too familiar interaction with her and we had not
even begun (the testing feedback). As we both sat down, she said
to me:
Jenny: You are hostile toward me!
Clinician: [taken aback, I look at her quizzically]
303
Jenny: Why do you ask me if you are not going to listen
to me?
Clinician: What do you mean [puzzled]?
Jenny: You said I did not learn anything from previous
testing. I never said that! I do not understand.
Clinician: Thats what you said to me [defensively]? What
would you like me to say instead [in an attempt to
move away from defensiveness to curiosity]?
Jenny: [shrugs her shoulders] You are not saying it is
your impression [angry tone]?
Clinician: You are right! I should have said that it is my
impression that you did not learn anything from
previous testing. It is in fact just my impression.
Jenny: Everyone loves you and you love everyone, but
you do not like me [angry tone].
Clinician: I am sorry. You think I like everyone but you
[feeling anxious . . . under attack]?
Jenny: I told you it was fine. Why would you say I did not
learn anything from previous testing [continues in
an angry, harsh, demanding tone]?
Clinician: You are right. I guess I brought up the previous
testing experience with the intent of making sure
that this one was helpful.
Jenny: But I already told you it was fine. I know I am
annoying. I am a pain in the ass. You guys do not
like me and want to punish me.
Clinician: Jenny, I am not aware of being angry with you. I
am thinking that if you think I love everyone but
you than you must feel very hurt?
Jenny: [shrugs her shoulders and stares back]
Clinician: Okay, lets just assume that I am angry with you
and want to punish you. What do you imagine I
am angry about?
Jenny: I am being difficult about medication and you are
annoyed with me and thats why you want to
attack me.
Clinician: To be honest, I am not your psychiatrist and you
are not bothering me with your frustration with
medication.
Jenny: Thats right. You are not my psychiatrist. But you
are angry that I am not talking about things with
you that you think would be helpful.
Clinician: Thats not true. Just yesterday you spoke openly
about your experience with the team in the rounds
and I found it very helpful. Jenny, I am trying to
think what do I do that may have led you to
conclude that I do not like you. Is it okay if I think
out loud with you? Although I am not aware of
being angry with you I do feel wary of my inter-
 304 SHARMA AND FOWLER
actions with you, as they tend to turn into strug-
gles with no apparent benefit to you or any res-
olution. I do admit that I find myself wanting to
avoid you and you may, understandably, experi-
ence me as cold and distant. Now, you do really
think that the staff is angry and want to punish
you and attack you? You know, interestingly, it
seems to relate very well with what I am observ-
ing on the test data.
I was taken aback by Jennys sudden accusation. Being con-
fronted directly with an error that I was yet to comprehend was
bewildering and disorganizing. Although I did recognize my mis-
take and apologized for it, I was not able to own my hostility and
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
defensiveness. I could not accept the possibility of being hostile
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and lacking in love or withholding it, and instead made a feeble
attempt to validate her anger and hurt. She repudiated my effort
and continued with what felt like a diatribe intended to block me
from going any further. However, feeling pressed for time and
anxious to complete the task of providing testing feedback, I did
not allow her to continue. For the time left in the session, we
discussed the test findings. She was notably quiet, although she did
let me know if she did not agree with my observations and
conclusions.
At the end of the meeting with Jenny, I felt relieved but also
uncertain about what had happened between Jenny and me. How-
ever, I did not think too much of it as it seemed part of the course,
albeit more intense. That night I was startled awake by a dream:
I saw myself up in the beautiful mountains with three friends. We had
gotten together to watch something, like friends get together to watch
a game of football or something but only in the mountains. In the next
scene, I was sitting at a table with my friends. One friend suggested
that we play a different game. The game was that we take turns in
naming a love story and the year it was published. I felt nervous and
thought to myself, Love story? What do I know about love stories? I
dont know any love stories. On my turn I said Harper Lee and I pain, coronary heart disease). However, in a recent review of
provided two different publication dates1938 or 1958. My friends
checked my answer against a document that listed names of the books
with the publication dates. My answer matched with the list and they
accepted my answer. I felt relieved.
When I awoke, I thought the dream might have something to do
with the exchange I had with Jenny, but what? Then I remembered
a few other details from the dream. One, I had chosen to name
Harper Lee because I felt more confident about knowing the date
it was published, not because I thought it was a love story. But by
naming Harper Lee I had changed the game from love to hate! I
thought more about my encounter with Jenny.
The following discussion selectively focuses on the interpreta-
tions and understandings from the dream as they relate with what
had gone on between me and Jenny. Rationally, I was attempting,
with tact and empathy, to do my work of sharing my understanding
of the test data in a timely manner. In fact, feeling pressed for time
to complete the task at hand had taken my attention away from
other potential factors that may have played a role in my eagerness
to provide feedback. I could not think that less rationally, perhaps
even automatically, I was reacting to Jenny with my personal fears.
Jenny was making demand for my love or expressing the hurt and
anger at the lack of my love. She was inviting me or even forcing
me to step into the uncomfortable unknown of love that I felt afraid
to explore and experience. So, unknowingly, I changed the focus
of the conversation from what was happening between her and me
in the here-and-now, to what I had set out to do in the first place,
provide testing feedbacka task that I felt definitely more confi-
dent and comfortable with. Not only this, in testing feedback I
tended to focus on Jennys fear of being attacked and her protec-
tive, yet defensive aggressive and mistrusting stance toward oth-
ers. Less consciously, I seemed to have joined her. Although she
was expressing her wish for my love, she clearly seemed more
comfortable in expressing her anger for the lack of my love instead
of her longing for it. Not surprisingly, both of us felt nervous in the
realm of love, needs, and desires and successfully avoided the
opportunity to explore and experience our fears by conveniently
hiding behind the therapeutic task.
Alternative Approaches to the Error
Shared Decision-Making
One, alternative way of approaching the above mentioned
scenario would be using the principles of shared decision-
making (Charles, Gafni, & Whelan, 1997; Eliacin, Salyers,
Kukla, & Matthias, 2015). Broadly speaking, shared decision-
making approach encourages the patients participation and
collaboration in treatment. The interventions under this ap-
proach focus on involving the patient in making treatment
decisions. Specifically, the clinician draws attention to the
identified problem that requires a decision-making process,
offers various ways to deal with the identified problem, ex-
plores the patients concerns about how the problem is to be
managed, and elicits the patients preferred level of involve-
ment in decision-making (Charles et al., 1997). Research on
shared decision-making in mental health is less developed than
in many other specialties (e.g., breast-conserving surgery, back
research on shared decision-making in mental health (Simon,
Wills, & Harter, 2009), studies showed that the adult patients
with psychiatric illnesses generally want an active participation
in making decision about their care. These studies also reveal
that shared decision-making interventions improve adherence
with treatment and satisfaction with care (Simon et al., 2009).
Underlying this approach are core principals of treating the
patient with dignity and respect, recognizing them as a person
with agency and respecting their knowledge. This has signifi-
cant implications for psychotherapeutic work, as it enables the
establishment of collaboration in a two-way communication
and a learning process. In other words, shared decision-making
interventions illustrate the process of trust and social learning
the how to of psychotherapeutic work.
In the clinical vignette, the clinician had a therapeutic task or
predetermined agenda and the patient had either come in with an
agenda or developed an agenda during the interaction. Instead of
trumping the patients concerns with the clinicians agenda, the
clinician could have involved the patient in making a decision
about how best to use the scheduled time together. For instance,
clinician could have said something to the effect of:
Clinician: I am wondering how we should proceed? On the one hand,
I had set this time for us to discuss test findings, which I would like
 THERAPEUTIC LISTENING
you to have time to think about and discuss before the diagnostic
conference. On the other hand, you are bringing to my attention and
providing me feedback about how you and I are doing. Not very well,
I am afraid, and I would like us time to think about and understand
your experience of feeling attacked by me and how I can contribute to
you feeling safe enough for us to work together.
Asking for or inviting the patients input would have allowed
the clinician to stay with the patients experience, in the here-and-
now, address her concern as she had stated early on (why do you
ask if you are not going to listen?), and find a way forward via
establishing trust (collaboration), the lack of which was the most
important clinical issue in work with her.
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Repairing Alliance Rupture
Second, the clinician could approach this clinical example
from the perspective of repairing alliance ruptures. Ruptures in
therapeutic alliance can be defined as events of tension or
breakdown in the collaborative relationship between the clini-
cian and the patient (Safran & Muran, 2006). The tension may
consist of disagreement about the tasks of therapeutic encoun-
ter, disagreement about the goals of treatment, and strains in the
affective bond related with misunderstanding, disrespect, and
mistrust (Bordin, 1979). Repairing alliance ruptures naturally
leads to building therapeutic alliance, which is consistently
supported in psychotherapy research as a robust predictor of
outcome across a range of different treatments (e.g., Martin,
Garske, & Davis, 2000; Safran, Muran, & Eubanks-Carter,
2011).
The patient had felt misunderstood, disrespected, and attacked
by the clinician. There were definitely parallels between the
clinicianpatient relationship and the patients other relationships,
as well as common patterns in her life but she consistently mini-
mized and denied these parallels. Although there is evidence to
suggest that it may prove useful to establish a link between the
rupture event and characteristic interpersonal pattern in the pa-
tients life, the clinician did not have the necessary therapeutic
relationship with the patient to allow for a useful transference
interpretation. There is some suggestion in the literature (e.g.,
Safran & Kraus, 2014) that premature attempts to establish the link
between the dynamic in the therapeutic relationship and other
relationships in the patients life may be experienced by the
patients as blaming. Furthermore, the clinicians attempts to re-
solve the rupture by clarifying the misunderstanding, responding in
a nondefensive fashion, and acknowledging her mistake met with
minimal success because the patient had difficulty exploring her
relationship in the here-and-now and the clinician had difficulty
accepting the possibility that she was being hostile. Both the
patient and the clinician had been injured and remained stuck in
the very familiar attacker-attacked dynamic. Both, in a way, dis-
owned their feelings of disappointment, hurt, vulnerability, and the
wish for nurturance and love. Early in the encounter the patient
was the victim of the clinicians attack, to which she reacted by
attacking the clinician. She was directly expressing her dissatis-
faction and anger and resentment toward the clinician in a blaming
and demanding fashion. The clinician, on the other hand, was
attempting to understand the rupture but also letting the patient
continue to attack her. The clinician could have made an effort to
305
explore what was going on between the two of them and may have
shifted the dynamic by saying something to the effect of:
Clinician: I find myself reflexively moving toward defending myself, in
part, I think, as a way to protect myself from your attack, which it
seems is exactly what you have been doing, defending yourself against
my attack. I am concerned that if we both continue doing this, it will
get in the way of you talking about what feels most live and important
to you in this moment.
In this situation, the clinician could have made the decision to
let the patient know about her impact on the clinician while
taking responsibility for her contribution to the interaction,
which would have provided a correcting contrast to the patients
anxious, fearful, and placating parents who rarely were forth-
right with her and provided her with minimal interpersonal
feedback.
Management of Countertransference
This clinical encounter could alternatively be approached
from the perspective of understanding and managing counter-
transference. The concept of countertransference was intro-
duced by Freud (1910). He viewed it as problematic, something
to be managed and done away with. Newer conceptions of
countertransference have emerged over the years. These have
been broadly categorized as totalistic, complementary, and re-
lational. The totalistic view considers all of the clinicians
reactions to the patient as countertransference (Kernberg, 1965;
Little, 1951; Racker, 1957; Winnicott, 1949). The complemen-
tary view takes the stance that all patients have a characteristic
tug or pull that invites complementary reactions from the
clinician, which allows for understanding of the patients inter-
personal style of relating (Racker, 1957; Winnicott, 1947). The
relational perspective on countertransference views it to be
mutually constructed by the patient and the clinician (Mitchell,
1993; Ogden, 2003; Renick & Spillius, 2004). Both the clini-
cian and the patient bring to the relationship their needs, unre-
solved conflicts, and behaviors, interactions of which contribute
to the countertransference reactions. Common to the various
conceptions of countertransference, as employed in most em-
pirical studies, is the notion that countertransference reactions
implicate clinicians unresolved conflicts as the source, and the
patients characteristics as the trigger. Also, countertransfer-
ence reactions are commonly viewed as inevitable and poten-
tially beneficial if the clinician examine and successfully un-
derstand their reactions and are able to use them to further the
understanding of the patient.
The clinician, early in her work with this patient, had been
experiencing continued strong nervousness, and reacting to her
in a controlled, muted manner. For her part, the patient was
narcissistically sensitive, demanding, confrontational young
woman with extreme difficulty regulating self-love and self-
worth and limited ability for collaborative interpersonal con-
nection. She negated the clinicians attempts to help her under-
stand how her interpersonal style might be contributing to her
ongoing interpersonal problems. She also usually negated any
observations about how she might be feeling underneath her
frustration and anger. Clearly the clinicians emotional distanc-
ing and wariness were natural given the patients negativity
 306 SHARMA AND FOWLER
and hostility. Yet, the clinicians unresolved anxiety about not
knowing how to respond to the patients intense longings for
love and nurturance, about fearing being overwhelmed by her
needs, and about fearing engulfment were clearly implicated in
the clinicians nervousness and her distancing reaction to the
patient, which was only brought to light by her dream.
Resolution of the Clinical Error
This set of reflections helped the clinician gain an apprecia-
tion of just how intensely she experienced the patients longings
and how anxious it made her. She was able to register a
perception of herself as hostile and defending herself against
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
the patients longing for love. This allowed her to mobilize an
This document is copyrighted by the American Psychological Association or one of its allied publishers.
aspect of herself that was interested in understanding her hos-
tility and distancing and cold behavior toward the patient,
instead of defensively managing it by denial, disguise, and
projection. As she came to understand her dynamic, she also
came to empathically grasp the emotions that were underlying
the patients hostility. The patient was distancing from her
terrifying longings for love and the clinician was colluding with
her. This understanding lessened the clinicians nervousness
and wariness. She returned to the patient the next day and
expressed curiosity about the exchange from the previous day.
Following is an approximation of the dialogue between them:
Clinician: I am curious about our relationship, especially
what happened between us yesterday. Would you
have some time and be willing to explore it with
me?
Jenny: We can talk right now.
Clinician: Thank you. As I thought more about our interac-
tion from yesterday I realize that my comment
about previous testing was defensive. I was ner-
vous about giving you feedback. I was anticipat-
ing that you will reject my observations and I
think by making a comment about previous test-
ing I was building my defense.
Jenny: Its interesting when you say that you were ner-
vous. My parents said something similar in the
family call yesterday. It was hurtful and made me
upset. I wish they would just tell me what they
think. I never know what they are really thinking.
Clinician: Hmm . . . Learning from my experience it seems
to me that as I managed my own anxiety about
upsetting you I deprived you of the feedback
about your impact on me. And, it left you feeling
anxious, angry and under attack without knowing
why. Does that resonate with you?
Jenny: Yes!
Clinician: I am also thinking that your tendency to lead with
anger and deny feelings of hurt perhaps makes it
hard to be straightforward with you.
Jenny: What do you mean?
Clinician: Well, looking back at our conversation from yes-
terday, I remember trying to reach out to you
about you feeling hurt thinking that I love every-
one but you, but you did not respond. I felt shut
down and it left me feeling that there is no point
in trying to reach out to you.
Jenny: [appears to be touched by my comment] You
know this is helpful.
The dialogue continued like this. Jenny associated to inter-
actions with her parents that left her feeling unsure, anxious,
and angry due to the lack of interpersonal feedback. She joined
me in exploring how her denial and disavowal of longings and
emotional needs contributed to the distancing and cold reac-
tions from me. Overall, she expressed appreciation for my
willingness to share my mind, instead of hiding it, and re-
sponded by sharing her own mind.
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Received July 22, 2016
Revision received August 2, 2016
Accepted August 6, 2016

Practice Review
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This is an open invitation for authors to submit what Charlie Gelso developed and termed a Practice Review for possible
publication in Psychotherapy. I want to continue this series as a step toward enhancing the value and relevance of scientific research
on psychotherapy and related processes to practice.
The general aim of the Practice Review is to clarify, as much as the current state of knowledge permits, what empirically-derived
findings in a given area imply for practice in that and related areas. In this type of review article, the reviewer begins the process
with the intent of deriving implications for practice from the research and theory that is examined. Much like program evaluation
research, the central question for the writer of a Practice Review may be phrased as: Despite the near inevitability of at least
somewhat mixed findings on virtually any topic, what is the most likely relationship between these variables, and what does that
relationship imply for the practitioner?
The above kind of question is based on an awareness that the practitioner must do his or her practice, despite the general lack
of fully consistent research findings; and it will be useful in that practice if the best available knowledge were used. This, of course,
is not to say that the reviewer may take a cavalier attitude toward drawing implications for practice. The reviewer needs to derive
such implications with great care. At the same time, the Practice Review does not convey the same degree of scientific skepticism
that is typical of the classical scholarly review. For example, in the traditional scholarly review, as in classical scholarly inquiry
in general, one takes a very conservative attitude toward accepting results. Substantial evidence must accumulate before we may
safely say a given finding is confirmed and valid. In the Practice Review, on the other hand, the investigator searches for the most
likely conclusion, when all evidence is weighed, and then seeks to place that conclusion within the context of practice.
The process of relating a most likely conclusion or finding to practice is rarely if ever a straightforward or linear process. As
but one example, the most likely conclusions about the role of duration of treatment in outcome is that, other things being equal,
the longer the therapy (at least up to a certain point), the more positive the outcomes. What implications does this have for the
practitioner? For implications to be drawn, this finding needs to be placed within the context of related findings, existing theory,
and other factors (e.g., pragmatic ones) that help the practitioner conceptualize duration factors in his or her practice. Placing
findings within contexts such as these may well modify the findings.
With these considerations in mind, the following guidelines are offered for those who write Practice Reviews:
1. Your set from the beginning should be to find out what are the most likely conclusions about the relationships under
investigation.
2. In doing so, consider how particular findings may be integrated with related findings in your area of review.
3. Once the most likely conclusions are arrived at and placed in the context of related knowledge, discuss what these findings
imply for the practitioner.
4. In relating findings to practice, show an appreciation of the likelihood that the findings-to-practice links will not be direct and
clear cut. Rather, given findings (facts) may relate to practice through their connection to theories, clinical wisdom, practical
and political concerns, etc.
5. Although the refrain, more research is needed, is virtually always valid, the practice review must not hide behind scientific
equivocation. Rather, the approach ought to be that, although more research is surely needed, here is our best available
knowledge and what it implies for practice.
Although the length of practice reviews should be dictated by the subject matter, such reviews generally should be limited to
about 25 pages of text. Reviews of relatively narrow topics should naturally be much briefer. Authors are invited to contact me if
they are considering writing such a review but have questions about the process. Email me at Psychotherapy@adelphi.edu.