Do patients internalize the positive regard they are offered? A dyadic test of a Rogerian condition

ABSTRACT

Objective

Positive regard (PR) reflects a therapist’s unconditional prizing of their patient, which meta-analytically correlates positively with patient improvement. However, most research has been limited to single-participant ratings of PR at a specific time, which neglects the dyadic and dynamic nature of PR (i.e., fundamental to benefitting from therapist-offered PR is that a patient internalizes it). Testing this premise, we hypothesized that therapist-offered PR at one session would predict patient-felt PR at a subsequent session (two sessions later), which would in turn predict the patient’s next-session outcome (within-patient mediation).

Method

Eighty-four patients with generalized anxiety disorder received cognitive–behavioral therapy with or without motivational interviewing. Therapists and patients provided postsession ratings of their offered and felt PR, respectively, at odd-numbered sessions throughout treatment. Patients rated their worry following each even-numbered session. We used multilevel structural equation modeling to test our hypothesis. We explored whether treatment condition moderated the mediational path.

Results

As predicted, when a therapist regarded their patient more than usual following one session, the patient felt more regarded than usual. In turn, this internalized regard was negatively associated with worry. Treatment condition did not moderate this path.

Discussion

Results support internalized positive regard as a treatment-common, ameliorative relationship process.

Keywords:

• positive regard
• treatment outcome
• within-person mediation
• generalized anxiety disorder
• cognitive–behavioral therapy
• motivational interviewing

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Supplemental Data

Supplemental data for this article can be accessed at https://doi.org/10.1080/10503307.2024.2350681.

Notes

1 However, across a 12-month follow-up period, MI-CBT demonstrated significantly better outcomes than standard CBT.

2 Although the Westra et al. (2016) trial included 85 patients, one patient requested after the trial that their data be excluded from any future analyses.

3 Although we determined statistical significance through the 95% credible intervals, to more closely match statistical conventions, we also provide two-tailed p-values for all relevant associations.

4 To compute the recommended effect sizes for DSEM, we replicated our primary mediation model, but allowed the a, b, and c’ paths to vary across patients (i.e., random slopes). This step allowed the Mplus program to first compute individually standardized parameter estimates for each patient before then taking the average of these individually standardized parameter estimates. Although we estimated this more complex model to generate effect sizes, due to the relatively small sample size in this study (and therefore limited statistical power), we present the results from the simpler random intercepts only model as our primary findings. However, it is worth noting that the parameter estimates were generally quite consistent across these two models.

5 Note that although a possible treatment effect on the model intercept was not of theoretical interest, we included this pathway to ensure proper model specification (i.e., the inclusion of all possible main effects when estimating interactions).

6 Although our mediational path model required temporal sequencing, it is plausible that therapist-offered regard might be even more strongly associated with patient-felt regard following the same session (i.e., more immediate internalization). Although this concurrent measurement is not ideal for mediation analyses, we nonetheless conducted a sensitivity analysis with therapist-offered and patient-felt regard measured after the same session to see if our results were consistent or notably changed. As indicated in Supplemental Figure 1, the results were consistent.

Additional information

Funding

This research was supported by the Canadian Institutes of Health Research [grant no MOP-114909].