{"title":"Supplemental Material for Increasing the Effectiveness of Psychotherapy in Routine Care Through Transdiagnostic Online Modules? Randomized Controlled Trial Investigating Blended Care","authors":"","doi":"10.1037/ccp0000983.supp","DOIUrl":"https://doi.org/10.1037/ccp0000983.supp","url":null,"abstract":"","PeriodicalId":15447,"journal":{"name":"Journal of consulting and clinical psychology","volume":"29 1","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145993392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Supplemental Material for Strengthening Couple Functioning to Enhance Child Outcomes in Low-Income Families: A Randomized Controlled Trial","authors":"","doi":"10.1037/ccp0000988.supp","DOIUrl":"https://doi.org/10.1037/ccp0000988.supp","url":null,"abstract":"","PeriodicalId":15447,"journal":{"name":"Journal of consulting and clinical psychology","volume":"1 1","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145993390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Supplemental Material for What Works for Whom in Outpatient Cognitive-Behavioral Therapy? Integration of Techniques From Different Therapeutic Orientations and Their Interactions as Predictors of Treatment Outcome in Different Diagnostic Groups","authors":"","doi":"10.1037/ccp0000987.supp","DOIUrl":"https://doi.org/10.1037/ccp0000987.supp","url":null,"abstract":"","PeriodicalId":15447,"journal":{"name":"Journal of consulting and clinical psychology","volume":"39 1","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145993393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Supplemental Material for Who Benefits Most From Couple Relationship Education: A Machine Learning Approach","authors":"","doi":"10.1037/ccp0000991.supp","DOIUrl":"https://doi.org/10.1037/ccp0000991.supp","url":null,"abstract":"","PeriodicalId":15447,"journal":{"name":"Journal of consulting and clinical psychology","volume":"76 1","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145993394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Supplemental Material for Why Are Some Cases Not on Track? An Investigation of Common Obstacles and Solutions During Feedback-Informed Psychological Therapy","authors":"","doi":"10.1037/ccp0000977.supp","DOIUrl":"https://doi.org/10.1037/ccp0000977.supp","url":null,"abstract":"","PeriodicalId":15447,"journal":{"name":"Journal of consulting and clinical psychology","volume":"178 1","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145993396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Carmen Schaeuffele,Augustin Mutak,Solveig Behr,Friederike Fenski,Leona Hammelrath,Marie Puetz,Steffi Pohl,Christine Knaevelsrud,Johanna Boettcher
OBJECTIVEBlended care (BC), the integration of Internet-based interventions into psychotherapy (PT), is thought of as a promising approach to enhance PT's effectiveness and efficiency. This randomized controlled trial aimed to investigate the effectiveness as well as the implementation and usage of BC with transdiagnostic online modules compared to PT in routine care in Germany. Routine outpatient PT is delivered by licensed psychotherapists across different therapeutic orientations (cognitive behavioral therapy, psychodynamic, systemic), with variable treatment lengths and procedures.METHODPsychotherapists in routine outpatient care recruited 1,159 patients who were randomized to BC or PT. The primary outcome was self-reported mental distress (the composite of anxiety and depression); secondary outcomes included self-reported satisfaction with life, level of functioning, eating pathology, and drug and alcohol use, as well as therapist-rated severity and changes. Outcomes were measured at baseline, 6 weeks, 12 weeks, 6 months, and 12 months. We examined whether BC and PT groups changed differently over time using linear mixed models. We also investigated differences in sessions and terminations and report usage metrics of the BC platform.RESULTSContrary to our hypotheses, we did not find differences between BC and PT in outcomes, including anxiety, depression, satisfaction with life, level of functioning, eating pathology, alcohol and drug use, therapist-rated severity, and satisfaction with treatment at 6 months postrandomization (all p > .05). BC and PT did not differ in the number of sessions or terminations. Regarding usage of the BC platform, 534 patients (91.6%) received at least one online chapter, with M = 7.26 (SD = 7.01) of a total of 39 online chapters assigned on average, and patients logged in M = 19.73 (SD = 24.66) times and spent M = 367.14 (SD = 338.27) minutes on the platform.CONCLUSIONSIn this real-world application of BC, therapists had considerable flexibility in implementing BC and integrating Internet-based interventions with sessions. Our findings suggest that the benefits observed in more structured BC setups may not fully translate to a flexible and transdiagnostic BC setup in routine care, potentially due to variations in implementation and adherence. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
{"title":"Increasing the effectiveness of psychotherapy in routine care through transdiagnostic online modules? Randomized controlled trial investigating blended care.","authors":"Carmen Schaeuffele,Augustin Mutak,Solveig Behr,Friederike Fenski,Leona Hammelrath,Marie Puetz,Steffi Pohl,Christine Knaevelsrud,Johanna Boettcher","doi":"10.1037/ccp0000983","DOIUrl":"https://doi.org/10.1037/ccp0000983","url":null,"abstract":"OBJECTIVEBlended care (BC), the integration of Internet-based interventions into psychotherapy (PT), is thought of as a promising approach to enhance PT's effectiveness and efficiency. This randomized controlled trial aimed to investigate the effectiveness as well as the implementation and usage of BC with transdiagnostic online modules compared to PT in routine care in Germany. Routine outpatient PT is delivered by licensed psychotherapists across different therapeutic orientations (cognitive behavioral therapy, psychodynamic, systemic), with variable treatment lengths and procedures.METHODPsychotherapists in routine outpatient care recruited 1,159 patients who were randomized to BC or PT. The primary outcome was self-reported mental distress (the composite of anxiety and depression); secondary outcomes included self-reported satisfaction with life, level of functioning, eating pathology, and drug and alcohol use, as well as therapist-rated severity and changes. Outcomes were measured at baseline, 6 weeks, 12 weeks, 6 months, and 12 months. We examined whether BC and PT groups changed differently over time using linear mixed models. We also investigated differences in sessions and terminations and report usage metrics of the BC platform.RESULTSContrary to our hypotheses, we did not find differences between BC and PT in outcomes, including anxiety, depression, satisfaction with life, level of functioning, eating pathology, alcohol and drug use, therapist-rated severity, and satisfaction with treatment at 6 months postrandomization (all p > .05). BC and PT did not differ in the number of sessions or terminations. Regarding usage of the BC platform, 534 patients (91.6%) received at least one online chapter, with M = 7.26 (SD = 7.01) of a total of 39 online chapters assigned on average, and patients logged in M = 19.73 (SD = 24.66) times and spent M = 367.14 (SD = 338.27) minutes on the platform.CONCLUSIONSIn this real-world application of BC, therapists had considerable flexibility in implementing BC and integrating Internet-based interventions with sessions. Our findings suggest that the benefits observed in more structured BC setups may not fully translate to a flexible and transdiagnostic BC setup in routine care, potentially due to variations in implementation and adherence. (PsycInfo Database Record (c) 2026 APA, all rights reserved).","PeriodicalId":15447,"journal":{"name":"Journal of consulting and clinical psychology","volume":"39 1","pages":"11-25"},"PeriodicalIF":5.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145971855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
OBJECTIVELarge-scale efforts have disseminated couple and relationship programs to strengthen couple relationships among low-income families, with the hope that doing so would yield benefits for partners and their children. The present study provided a rigorous test of this hypothesis by examining indirect effects of a couple-focused preventive intervention on child outcomes in a large sample of low-income families.METHODData were drawn from the Supporting Healthy Marriage evaluation, in which 6,298 low-income married couples with children were randomized to a relationship education intervention with supplemental activities and family support services or to a control condition. Couple relationship functioning was assessed 12 months postrandomization, and five child outcomes (self-regulation, internalizing behavior problems, externalizing behavior problems, cognitive and academic performance, and social competence) were assessed 30 months postrandomization.RESULTSStructural equation models revealed that the intervention had significant indirect effects on children's self-regulation, internalizing behavior problems (children younger than 14 years), externalizing behavior problems (children younger than 14 years), cognitive and academic performance (children older than 5 years), and social competence, through enhanced couple functioning.CONCLUSIONSParticipation in a couple-focused intervention had significant indirect effects on low-income couples' children 30 months later through intervention-derived improvements in the couple relationship. These results suggest that strengthening couple relationships may be a viable option to indirectly promote child well-being in low-income families. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
{"title":"Strengthening couple functioning to enhance child outcomes in low-income families: A randomized controlled trial.","authors":"Justin A Lavner,Po-Heng Chen,Hannah C Williamson","doi":"10.1037/ccp0000988","DOIUrl":"https://doi.org/10.1037/ccp0000988","url":null,"abstract":"OBJECTIVELarge-scale efforts have disseminated couple and relationship programs to strengthen couple relationships among low-income families, with the hope that doing so would yield benefits for partners and their children. The present study provided a rigorous test of this hypothesis by examining indirect effects of a couple-focused preventive intervention on child outcomes in a large sample of low-income families.METHODData were drawn from the Supporting Healthy Marriage evaluation, in which 6,298 low-income married couples with children were randomized to a relationship education intervention with supplemental activities and family support services or to a control condition. Couple relationship functioning was assessed 12 months postrandomization, and five child outcomes (self-regulation, internalizing behavior problems, externalizing behavior problems, cognitive and academic performance, and social competence) were assessed 30 months postrandomization.RESULTSStructural equation models revealed that the intervention had significant indirect effects on children's self-regulation, internalizing behavior problems (children younger than 14 years), externalizing behavior problems (children younger than 14 years), cognitive and academic performance (children older than 5 years), and social competence, through enhanced couple functioning.CONCLUSIONSParticipation in a couple-focused intervention had significant indirect effects on low-income couples' children 30 months later through intervention-derived improvements in the couple relationship. These results suggest that strengthening couple relationships may be a viable option to indirectly promote child well-being in low-income families. (PsycInfo Database Record (c) 2026 APA, all rights reserved).","PeriodicalId":15447,"journal":{"name":"Journal of consulting and clinical psychology","volume":"5 1","pages":"39-48"},"PeriodicalIF":5.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145971856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
OBJECTIVECouple relationship education (CRE) seeks to enhance relationship functioning and prevent deterioration of relationship quality over time. However, impacts of CRE are mixed and often appear to be influenced by the characteristics of the couples receiving the intervention. To provide effective interventions, a better understanding of the couples who are most likely to benefit from CRE is needed. Unfortunately, the existing literature has failed to account for the complex and interdependent nature of pretreatment risk factors, leading to inconsistent and inconclusive results.METHODThe present study addresses this issue by applying causal forest, a machine learning technique, to two randomized controlled trials of CRE to determine the pretreatment characteristics that are most predictive of treatment outcomes. In Study 1, data from 6,298 couples were used to train causal forest algorithms, and in Study 2, data from 1,595 couples were used to test the accuracy and generalizability of the trained models.RESULTSCausal forest models indicated that pretreatment characteristics predicted 12-month treatment effects, such that participants with higher psychological distress and lower baseline relationship happiness experienced greater improvements in relationship happiness, while those with higher psychological distress and perceived stress had greater reductions in negative emotions and behaviors within the relationship. These results were robust when tested in a novel data set.CONCLUSIONSThis research highlights the underlying heterogeneity in CRE treatment effects and demonstrates the ability of machine learning methods to identify who may benefit most from CRE and can inform efforts to improve targeting of these interventions. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
{"title":"Who benefits most from couple relationship education: A machine learning approach.","authors":"Po-Heng Chen,Hannah C Williamson","doi":"10.1037/ccp0000991","DOIUrl":"https://doi.org/10.1037/ccp0000991","url":null,"abstract":"OBJECTIVECouple relationship education (CRE) seeks to enhance relationship functioning and prevent deterioration of relationship quality over time. However, impacts of CRE are mixed and often appear to be influenced by the characteristics of the couples receiving the intervention. To provide effective interventions, a better understanding of the couples who are most likely to benefit from CRE is needed. Unfortunately, the existing literature has failed to account for the complex and interdependent nature of pretreatment risk factors, leading to inconsistent and inconclusive results.METHODThe present study addresses this issue by applying causal forest, a machine learning technique, to two randomized controlled trials of CRE to determine the pretreatment characteristics that are most predictive of treatment outcomes. In Study 1, data from 6,298 couples were used to train causal forest algorithms, and in Study 2, data from 1,595 couples were used to test the accuracy and generalizability of the trained models.RESULTSCausal forest models indicated that pretreatment characteristics predicted 12-month treatment effects, such that participants with higher psychological distress and lower baseline relationship happiness experienced greater improvements in relationship happiness, while those with higher psychological distress and perceived stress had greater reductions in negative emotions and behaviors within the relationship. These results were robust when tested in a novel data set.CONCLUSIONSThis research highlights the underlying heterogeneity in CRE treatment effects and demonstrates the ability of machine learning methods to identify who may benefit most from CRE and can inform efforts to improve targeting of these interventions. (PsycInfo Database Record (c) 2026 APA, all rights reserved).","PeriodicalId":15447,"journal":{"name":"Journal of consulting and clinical psychology","volume":"34 1","pages":"49-62"},"PeriodicalIF":5.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145971916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hannah van Alebeek,Louisa D'Errico,Jaime Delgadillo,Ulrike Dinger,Johannes C Ehrenthal,Franziska Pfannerstill,Johannes Mander,Thomas Probst
OBJECTIVEThe mechanisms underlying psychotherapy's effects remain debated, with some emphasizing theory-specific therapeutic techniques and others highlighting common factors like therapeutic alliance. Evidence is inconclusive partially because it is rarely assessed which interventions are actually employed in naturalistic outpatient settings. The study thus examined (a) how patient- and therapist-reported interventions during cognitive-behavioral therapy predict outcome, (b) whether naturally occurring integration of intervention from different therapeutic orientations predicts a more or less favorable outcome, and (c) whether the intervention-outcome association depends on specific diagnoses.METHODUsing the Multitheoretical List of Therapeutic Interventions, 1,050 patients diagnosed with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (Mage = 34.65, 58% female), and their 161 cognitive-behavioral therapy therapists reported which interventions were employed during psychotherapy. The patient-reported outcome, the Brief Symptom Checklist, was assessed at the beginning and end of therapy.RESULTSBayesian multilevel regression models revealed that patient-reported interventions were more consistently associated with the outcome than therapist-reported interventions. The person-centered subscale-especially reports on the exploration of personal meaning-emerged as the strongest predictor of the outcome. Integration of most interventions (i.e., reports on two subscales of the Multitheoretical List of Therapeutic Interventions) did not predict a more positive or negative outcome, though few combinations were beneficial. Findings regarding stronger intervention-outcome associations for specific diagnoses were not robust.CONCLUSIONBy leveraging natural variability in routine clinical practice, this study provides insights into psychotherapy mechanisms beyond controlled trial constraints. It highlights the relevance of patients' perspective and the integration of interventions targeting meaning in predicting the outcome in outpatient cognitive-behavioral therapy. In addition, there seem to be no advantages nor adverse consequences of integrating therapeutic techniques. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
{"title":"What works for whom in outpatient cognitive-behavioral therapy? Integration of techniques from different therapeutic orientations and their interactions as predictors of treatment outcome in different diagnostic groups.","authors":"Hannah van Alebeek,Louisa D'Errico,Jaime Delgadillo,Ulrike Dinger,Johannes C Ehrenthal,Franziska Pfannerstill,Johannes Mander,Thomas Probst","doi":"10.1037/ccp0000987","DOIUrl":"https://doi.org/10.1037/ccp0000987","url":null,"abstract":"OBJECTIVEThe mechanisms underlying psychotherapy's effects remain debated, with some emphasizing theory-specific therapeutic techniques and others highlighting common factors like therapeutic alliance. Evidence is inconclusive partially because it is rarely assessed which interventions are actually employed in naturalistic outpatient settings. The study thus examined (a) how patient- and therapist-reported interventions during cognitive-behavioral therapy predict outcome, (b) whether naturally occurring integration of intervention from different therapeutic orientations predicts a more or less favorable outcome, and (c) whether the intervention-outcome association depends on specific diagnoses.METHODUsing the Multitheoretical List of Therapeutic Interventions, 1,050 patients diagnosed with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (Mage = 34.65, 58% female), and their 161 cognitive-behavioral therapy therapists reported which interventions were employed during psychotherapy. The patient-reported outcome, the Brief Symptom Checklist, was assessed at the beginning and end of therapy.RESULTSBayesian multilevel regression models revealed that patient-reported interventions were more consistently associated with the outcome than therapist-reported interventions. The person-centered subscale-especially reports on the exploration of personal meaning-emerged as the strongest predictor of the outcome. Integration of most interventions (i.e., reports on two subscales of the Multitheoretical List of Therapeutic Interventions) did not predict a more positive or negative outcome, though few combinations were beneficial. Findings regarding stronger intervention-outcome associations for specific diagnoses were not robust.CONCLUSIONBy leveraging natural variability in routine clinical practice, this study provides insights into psychotherapy mechanisms beyond controlled trial constraints. It highlights the relevance of patients' perspective and the integration of interventions targeting meaning in predicting the outcome in outpatient cognitive-behavioral therapy. In addition, there seem to be no advantages nor adverse consequences of integrating therapeutic techniques. (PsycInfo Database Record (c) 2026 APA, all rights reserved).","PeriodicalId":15447,"journal":{"name":"Journal of consulting and clinical psychology","volume":"30 1","pages":"26-38"},"PeriodicalIF":5.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145971918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
OBJECTIVESUsing feedback helps to improve psychological treatment outcomes, particularly for patients whose symptom trajectory is not-on-track. However, little is known about why some cases are not-on-track and what strategies can help to improve their treatment response. This study aimed to examine common obstacles and solutions identified by feedback-using therapists.METHODA cohort of therapists (N = 10) used a feedback algorithm that classified cases as on-track or not-on-track using session-by-session measures of depression (Patient Health Questionnaire-9) and anxiety (Generalized Anxiety Disorder-7). They followed a structured protocol to identify obstacles and potential solutions in not-on-track cases, and to document these using qualitative case notes. Case notes from 192 therapy sessions (across N = 44 cases) were analyzed using topic modeling, a machine learning approach to process qualitative data.RESULTSCommon obstacles were: (a) impact of traumatic experiences, (b) indicators of resistance, (c) social/interpersonal problems, (d) stressful life events, and (e) therapy process problems. Common solutions included: (a) strengthening agreement on goals and tasks, (b) enhancing focality, (c) individualized case formulation, and (d) enhancing expectations and motivation for change.CONCLUSIONSConsistent with prior quantitative research, the topics identified in this qualitative study generally reflected problems related to motivation/resistance or interpersonal/relational problems. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
{"title":"Why are some cases not on track? An investigation of common obstacles and solutions during feedback-informed psychological therapy.","authors":"Eleanor Williams,Heidi Christensen,Elisa Aguirre,Jon Wheatley,Adam Corfe,Janet Thomson,Jaime Delgadillo","doi":"10.1037/ccp0000977","DOIUrl":"https://doi.org/10.1037/ccp0000977","url":null,"abstract":"OBJECTIVESUsing feedback helps to improve psychological treatment outcomes, particularly for patients whose symptom trajectory is not-on-track. However, little is known about why some cases are not-on-track and what strategies can help to improve their treatment response. This study aimed to examine common obstacles and solutions identified by feedback-using therapists.METHODA cohort of therapists (N = 10) used a feedback algorithm that classified cases as on-track or not-on-track using session-by-session measures of depression (Patient Health Questionnaire-9) and anxiety (Generalized Anxiety Disorder-7). They followed a structured protocol to identify obstacles and potential solutions in not-on-track cases, and to document these using qualitative case notes. Case notes from 192 therapy sessions (across N = 44 cases) were analyzed using topic modeling, a machine learning approach to process qualitative data.RESULTSCommon obstacles were: (a) impact of traumatic experiences, (b) indicators of resistance, (c) social/interpersonal problems, (d) stressful life events, and (e) therapy process problems. Common solutions included: (a) strengthening agreement on goals and tasks, (b) enhancing focality, (c) individualized case formulation, and (d) enhancing expectations and motivation for change.CONCLUSIONSConsistent with prior quantitative research, the topics identified in this qualitative study generally reflected problems related to motivation/resistance or interpersonal/relational problems. (PsycInfo Database Record (c) 2026 APA, all rights reserved).","PeriodicalId":15447,"journal":{"name":"Journal of consulting and clinical psychology","volume":"39 1","pages":"1-10"},"PeriodicalIF":5.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145971917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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