Psychotherapy最新文献

The primary proposed change process in emotion-focused therapy models for couples involves partners accessing and revealing vulnerable emotions and responding to such disclosures with empathy and compassion. Therapists often use enactments (guiding partners to communicate with each other directly) to facilitate this process. However, many therapists report lacking confidence and clarity in how best to facilitate enactments, and it remains understudied which therapist interventions within enactment episodes contribute to vulnerability sharing and responsiveness expression. This preregistered study examined the role of three interventions used during enactments-systemic meaning-making (narrating), emotional engagement (experiencing), and interaction guiding (choreographing) in promoting these processes. One hundred forty enactment events from 21 treatment couples were coded and analyzed. Trained raters coded therapists' interventions and partners' behaviors. In contrast to our hypothesis, systemic meaning-making and interaction guiding were not associated, and emotional engagement was only marginally associated with greater vulnerability expression. Interaction guiding was positively associated with responsiveness. However, systemic meaning-making was negatively associated with responsiveness, and emotional engagement was not associated with responsiveness. Vulnerability expression did not predict partner responsiveness. These findings highlight the importance of tailoring therapist interventions in enactments according to their distinct contributions to facilitating vulnerability and responsiveness. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Integrating spirituality and religiousness (S/R) into mental health (MH) treatment aligns with our ethics codes and professional guidelines, and it can promote therapeutic outcomes. There is emerging evidence among samples of professional clinicians and graduate students that the Spirituality Competency Training in MH curriculum (SCT-MH; Pearce et al., 2019) may address the dearth of training in this intersection. However, SCT-MH needs to be assessed among undergraduates to support vocational development and those who pursue graduate school or bachelor-level mental health work. In this exploratory pedagogical study, we used a series of repeated measures analyses of variance to assess undergraduate students' (N = 39) attitudes toward a revised version of the Attitudes subscale of the S/R integration into MH Scale (Oxhandler & Parrish, 2016), the Social Justice Scale (SJS; Torres-Harding et al., 2012), and single-item scales focused on pursuing MH-focused work postdegree across teaching-as-usual and SCT-MH curricula. During teaching-as-usual, there were no significant increases in attitude scores regarding S/R integration (p = .25) or SJS (p = .4). However, there were significant increases in attitudes toward S/R integration (p < .001) and SJS during the SCT-MH curriculum (p < .001). In neither arm did interest single-item scores on pursuing MH graduate school (p = .68) or vocationally (p = .05) increase. While not causal, these increases during SCT-MH regarding attitudes toward S/R MH integration and social justice attitudes and behaviors are noteworthy. Further extension using vocational assessment, longitudinal and experimental designs, and diverse multisite samples are needed. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Research does not consistently support the widely held assumption that therapist trainees' skills improve with supervised experience, leading to better client outcomes. The inconsistent findings are limited by methodological constraints. Measures of therapist trainee experience (e.g., training level, years since first client contact) fail to capture clinical experience accurately. Therefore, we operationalized therapist trainees' experience as the total hours of previous client contact under clinical supervision at the time of outcome assessment. We examined how therapist trainees' client contact hours (at the within-person level), client order, initial client distress, and treatment length are associated with client distress in the subsequent week. We used dynamic structural equation modeling to analyze longitudinal data with 1,125 outcome assessments from 192 clients and 45 doctoral-level therapist trainees, collected over 16 years. Therapists received weekly individual supervision and biweekly group supervision. Results indicated that at the within-person level, therapist trainee experience was modestly associated with reduced client distress, particularly for clients with higher initial distress. At the between-person level, therapist trainees' experience had a stronger impact on outcomes in shorter treatment lengths. Findings reveal the complexity of the therapist trainee experience-client outcome relationship and suggest that the effects of therapist trainee experience are contingent on other variables. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

The aim of this study was to investigate the degree of commonality between young people's perceptions of the alliance and the therapist interpersonal skills (TIS) of empathy, unconditional positive regard, and congruence. Participants were 152 young people (aged 13-16 years old; 114 female, 70 of minoritized ethnicities) who were experiencing moderate to severe levels of emotional symptoms and participated in up to 10 sessions of school-based humanistic counseling. At 6 weeks postrandomization, TIS and the alliance were assessed using the Barrett-Lennard Relationship Inventory: Form OS-40: T-S (Student Form, Version 3) and the Working Alliance Inventory Short Form, respectively. Structural equation modeling was used to identify latent constructs. A model with two correlated second-order factors and a hierarchical model with one third-order general factor exhibited the best data fit. The general factor, which we named youth-perceived relationship quality, explained a substantial amount of variance for TIS (81%) and alliance (98%). TIS and alliance effects, treated independently, explained an additional 3% and 1.4% of variance in satisfaction with care and psychological difficulties after therapy, respectively, as compared with general youth-perceived relationship quality. While therapeutic relationship factors-in clinical practice, training, and research-are often considered distinct, we found a high degree of commonality in how young people perceived the alliance and TIS. Further research is warranted on youth-perceived relationship quality as an integrated variable in youth psychotherapy. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Routine outcome monitoring (ROM) has become an increasingly utilized tool in therapeutic practice that has the potential to improve therapy outcomes. This study aimed to synthesize the findings of existing qualitative studies investigating facilitators and barriers to clinicians' implementation of ROM in their practice. A systematic search of qualitative studies on clinicians' experience with the use of ROM in mental health services was conducted via APA PsycInfo, APA PsycArticles, Medline, Web of Science, and Scopus databases. Qualitative meta-analysis was used to synthesize the findings of the primary studies. Fifty-eight studies met the inclusion criteria. The analysis resulted in 22 metacategories organized into five clusters: (a) perceived clinical relevance, (b) institutional aspects, (c) practical aspects, (d) client variables, and (e) clinicians' personal reactions. The meta-analysis revealed that the implementation of ROM into clinicians' psychotherapy practice is influenced by many factors, including practical circumstances such as the work environment, the clientele, and the chosen ROM system. Clinicians' attitude to ROM, its perceived usefulness, and their openness to receiving feedback on their work are also important variables. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

This study examined changes in emotion regulation difficulties during short-term dynamic psychotherapy and their temporal relationship with symptom change, considering attachment styles as potential moderators. Sixty-three patients with mild to moderate depression and/or anxiety underwent 16 weeks of supportive-expressive therapy. Emotion regulation difficulties, symptoms, and attachment styles were assessed using self-report measures. Contrary to hypotheses, no overall improvement in emotion regulation difficulties was observed. However, patients with high attachment avoidance showed increased emotional clarity, while those with anxious attachment demonstrated greater acceptance of negative emotions over time. A deterioration in emotion regulation strategies was observed across all patients, particularly among those with avoidant attachment. Cross-lagged panel analysis revealed complex temporal dynamics: bidirectional relationships between emotion regulation and symptoms during early sessions, decoupling in intermediate sessions, and unidirectional effects (regulation predicting symptoms) in late sessions. These findings highlight the complex phase-dependent dynamics of emotion regulation change in short-term psychodynamic psychotherapy. The results emphasize the importance of considering both treatment phase and attachment styles when addressing emotion regulation difficulties in therapy. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Employment status, an essential socioeconomic factor, may be an important driver of disparities in mental health and access to treatment. However, prior research has been inconclusive and utilized broad employment categories. The present study investigated the associations between various types of employment status and baseline symptomology, psychotherapy engagement, and psychotherapy outcomes. We examined 27,258 patients (Mage = 32.54; 62.9% female; 75.8% White) who attended 115,936 psychotherapy sessions at a Canadian mental health agency between January 2014 and July 2022. Employment status was categorized into nine distinct groups (e.g., full-time, part-time, unemployed and looking for work, unemployed not looking for work, and retirement). Multilevel models examined the association between employment status and baseline symptoms, psychotherapy engagement (e.g., total sessions, early termination), and outcomes (e.g., symptom change). Patients who were unemployed (both looking for and not looking for work) reported higher baseline symptoms and increased odds of suicide concern compared to patients with full-time employment. Contrary to our preregistered hypotheses, patients who were unemployed attended more sessions and showed no significant differences in symptom change or trajectory of change compared to those employed full-time. Retirement was linked to lower baseline symptomology, and both retirement and full-time student status were associated with slower trajectories of change relative to full-time employment. Findings suggest that unemployment is associated with worse baseline mental health but does not hinder psychotherapy engagement and effectiveness. Ensuring accessibility of psychotherapy for unemployed individuals is crucial, given their heightened risk of psychological distress. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Positive regard (PR)-rated from multiple perspectives across diverse psychotherapies-correlates positively with patient improvement. Yet, existing research has generally not parsed this total correlation into its within- and between-therapist components, which limits its interpretability. Thus, the present study explored (a) the association between positive regard and outcome at both the within- and between-therapist levels, (b) whether between-therapist differences in positive regard moderated the within-therapist positive regard-outcome association, and (c) whether treatment condition (cognitive-behavioral therapy [CBT] vs. CBT that integrated client-centered principles) moderated either level of the positive regard-outcome association. Adults with generalized anxiety disorder were randomly assigned to CBT alone (n = 49) or CBT integrated with motivational interviewing (MI-CBT; n = 52) to responsively address patient resistance (Westra et al., 2016). Ten therapists treated patients in CBT only, and nine distinct therapists treated patients in MI-CBT only. Patients rated therapist-offered positive regard repeatedly across 15 sessions and their worry and general distress outcomes at baseline and posttreatment. Multilevel structural equation modeling revealed a significant association between patients' experience of higher early treatment positive regard and lower posttreatment worry and general distress at the within-therapist level. There was no between-therapist association for either outcome. Additionally, neither between-therapist positive regard nor treatment condition moderated the within-therapist effect of positive regard on either outcome. Results underscore the value of therapists working to foster their patients' felt regard irrespective of the treatment they use or the general ability they have in cultivating this relational experience. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Prior scholarship has helped demonstrate therapists' perceptions of the value of discussing anti-Black racism with Black clients in a manner that espouses cultural comfort or the ability to be at ease when discussing lived experiences related to clients' culture during treatment. Better understanding cultural comfort, an aspect of multicultural orientation, when discussing anti-Black racism with Black clients could help clarify paths by which psychotherapy does not perpetuate harm reflected in the dehumanization of such racism. However, Black clients' perspectives are missing in the literature. As such, we collected data from 153 Black participants with recent therapy experiences. They were asked about discussing anti-Black racism during therapy, satisfaction/helpfulness of these conversations, and items related to initiation and frequency of such discussions. Participants also completed measures of cultural comfort, working alliance, and perceived outcome. Perceived therapist cultural comfort did not significantly vary if anti-Black racism was discussed, and discussing anti-Black racism did not moderate the relationship between cultural comfort and working alliance or cultural comfort and outcome. Satisfaction and helpfulness positively correlated with cultural comfort. Cultural comfort scores also varied by who initiated these conversations and their frequency. We contextualize these findings in a need for greater nuance with respect to examining discussions of racism in psychotherapy and consider our findings with respect to broaching literature. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Abundant research across various treatments indicates that therapists can differ in their general, caseload-level effectiveness. However, relatively little is known about therapist factors that predict such "performance" variability. Moreover, most of the limited existing work on this topic has relied on demographic and professional convenience variables, which have demonstrated low predictive power. Thus, it is possible that therapist effectiveness differences would be better explained by personality characteristics that are inescapably present in a clinician's work. Addressing this question, the present preregistered study preliminarily explored whether more versus less effective therapists possess more adaptive personality traits among the "big five," defense style maturity, and psychological mindedness. Data were derived from a randomized clinical trial comparing the efficacy of 16 sessions of cognitive behavioral therapy and psychodynamic therapy for depression (Driessen et al., 2013). Effective sample participants were 142 adult outpatients treated by 32 therapists nested within the treatment condition. Therapists completed multiple personality measures, and patients' depression and global distress symptoms were assessed (via self-report or observer ratings) at baseline and posttreatment. Despite there being significant between-therapist effectiveness differences (on their average patient's posttreatment outcome), multilevel models revealed no significant associations between personality characteristics and such differences on any outcome. It may be that therapists' overall effectiveness has more to do with their transferable actions in the room versus traits they bring into their work. Alternatively, certain traits may predict between-therapist effects but only in specific treatment, patient, and/or cultural contexts that differ from the ones herein. (PsycInfo Database Record (c) 2025 APA, all rights reserved).