Transactions between therapists and depressed clients: A cognitive-interpersonal model of therapists' perception and bias

Robert J. Montano (1993)

This study integrated theoretical concepts relevant to Beck's cognitive model of therapy and Sullivan's interpersonal model of therapy. These concepts were also integrated with theories by: Neisser on interpersonal perception; Coyne on the interpersonal processes of depression; Greenberg and Safran on emotional processing; and, Leventhal on emotional synthesis. This study examined the preconceptions and biases of the therapist's perceptual processes when interacting with a depressed client and that client's interpersonal evoking messages and precipitating events. The therapist's prototypes of depression were viewed as guiding all future information-processing with a depressed client in the areas of cognition, emotion, and behavior. The therapist's prototypes of depression were also viewed as contributing to biasing effects that reconfirm a therapist's perceptual assessment of a depressed client. Evoking messages and precipitating events were viewed as the interpersonal dimensions of therapist perception as well as the interpersonal prototypic dimensions of client depression. A cyclical cognitive-interpersonal model of therapist-depressed client interactions was developed. An emotional information-processing model showed how the therapist decodes, modifies, synthesizes, and encodes cognition and emotion simultaneously by assimilating client impact messages into preexisting prototypes or accommodating them into new person prototypes. Training was discussed to debias the therapist relative to a qualitative analysis of interpersonal patterns of client depression, a taxonomy of prototypical interpersonal depressed client styles, and an interactive video debiasing program. The model's theoretical strengths and weaknesses were examined, and its relevancy was discussed for future psychotherapy outcome research studies. A concluding caveat discussed an integration of therapist and researcher roles relative to the proposed model.