Psychotherapy最新文献

The current literature for the various mental health professions is replete with studies demonstrating the critical importance of addressing spiritual and religious concerns in mental health treatment, yet many clinicians remain untrained in spiritual and religious competence. In recent years, researchers have developed training programs to support clinicians' understanding of how spirituality influences mental health and provided resources for how clinicians can address it with clients. The present study investigates the effectiveness of two online training programs, Spiritual Competency Training in Mental Health (SCT-MH) and a contemplative pedagogy-based program called Multicultural Orientation and Contemplative Awareness (MOCA), in enhancing spiritual and religious competence among counselors. We conducted a three-parallel-arm randomized controlled trial with a sample of practicing counselors to compare the SCT-MH (n = 10), MOCA (n = 15), and a wait-list control group (n = 29). We recruited our sample from state licensure boards for mental health practitioners, alumni listservs for counseling programs, and social media marketing. Additionally, the study examined the explanatory role of cultural humility on spiritual competence over time. Linear mixed modeling revealed a significant interaction between group and time, demonstrating that the SCT-MH group had a large effect and MOCA had a moderate effect in improving clinicians' total spiritual competence score compared with the control group. The findings suggest that both SCT-MH and MOCA can effectively enhance spiritual competence in counselors and cultural humility plays a significant role in this development. Implications and recommendations for implementation are discussed. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

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).

Corrective relational experiences (CREs) occur specifically within the therapeutic relationship and are perceived by patients as distinct and meaningful. Despite their potential importance in facilitating therapeutic change, CREs received limited theoretical, clinical, and empirical attention. The present study aimed to identify different types of CREs and to examine whether they suggest distinct mechanisms of change. Posttreatment semistructured qualitative interviews with 57 patients diagnosed with major depressive disorder following short-term supportive-expressive psychodynamic psychotherapy uncovered 21 CREs. Four ideal types were identified: experiencing empathic engagement, experiencing nonjudgmental acceptance, experiencing new understanding or insight, and experiencing encouragement and empowerment. All patients who reported a CRE also described intrapersonal growth, and most reported an improved relationship with their therapist following the CRE. Our findings highlight the enduring impact of these experiences, even years after the conclusion of therapy, providing a more nuanced understanding of how they may drive positive change in the treatment of individuals with major depressive disorder. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Adding nuance to the between-therapist effect on patient outcomes, research has increasingly demonstrated that a given therapist can differ in their effectiveness depending on who they treat (e.g., patients with different racial/ethnic identities) and/or what they treat (e.g., patients with different presenting problems). This preregistered study examined whether individual therapists are also more or less effective depending on how they treat their patients; that is, delivering one type of therapy versus another. We did so in the context of an individual participant data meta-analysis of clinical trials that compared classes of cognitive-behavioral therapy and psychodynamic therapy for depression. The meta-analytic sample included 30 therapists who were crossed with treatment condition and 492 patients (M = 25.08 patients per therapist; SD = 15.77). Patients completed measures of depression at baseline and posttreatment. Multilevel structural equation models revealed significant variability in the within-therapist treatment condition-outcome association (p < .001), indicating that some therapists were more effective when delivering one treatment over the other. Descriptively, 53% of therapists had similar outcomes across both groups (d < .20), whereas 47% had at least a small-sized treatment-type strength (d ≥ .20; range = 0.21-0.65). Results inform the personalization of treatment usage to the individual provider's effectiveness data. (PsycInfo Database Record (c) 2026 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).

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).

Despite evidence from randomized controlled trials of long-term psychodynamic psychotherapy's (LTPP's) efficacy in treating depression, qualitative research on patient perspectives remains limited. This study aims to provide a deeper understanding of patient experiences, including perceived therapeutic mechanisms, challenges, and benefits, in LTPP. A qualitative study using naturalistic, semistructured interviews was conducted with 12 adult patients (six male, six female) from Australia and New Zealand/Aotearoa. Participants had received an average of 7.8 years of LTPP. Interviews were analyzed using reflexive thematic analysis to identify core themes related to treatment access, engagement, therapeutic change, and outcomes. Six themes were developed (a) experiences with prior treatments, (b) initial challenges in engaging with LTPP, (c) the centrality of the therapeutic relationship, (d) gaining self-insight, (e) experiences of internal change, and (f) the emotional and financial costs of long-term therapy. Participants described LTPP as a challenging yet transformative treatment, facilitating affect regulation, self-compassion, and improved interpersonal functioning. Participants attributed benefits to their LTPP treatments and emphasized the importance of a stable therapeutic relationship and insight in subjective improvement. However, they also described the process as emotionally painful and resource intensive. These findings indicate that patient experiences of LTPP are broadly consistent with psychodynamic theories of change and underscore the importance of integrating patient perspectives into psychotherapy research and policy. (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).

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) 2026 APA, all rights reserved).

Understanding clinician perspectives and preferences is critical to advancing measurement-based care (MBC) training and implementation efforts. Yet, clinician perceptions of these and how they relate to MBC uptake are understudied. This mixed methods study aimed to evaluate clinicians' MBC training perceptions, posttraining MBC use, and predictors of MBC uptake. Clinicians in Department of Defense settings completed surveys immediately (N = 366) and 1 month (n = 88) posttraining. Most viewed MBC training as relevant (89.5%) and useful (81.8%); similarly, most were confident using symptom (87.9%) and alliance measures (89.3%) posttraining. Whereas 65.9% consistently used symptom measures posttraining, only 26.2% consistently used alliance measures, and about half did not regularly discuss those completed measures with clients. Using Bayesian logistic regression models, MBC use was linked with higher training relevance and usefulness ratings, reporting that training materials were understood and facilitated learning, and greater knowledge and confidence using MBC. Discipline and theoretical orientation were not significantly linked. Using reflexive thematic analysis, qualitative themes included clinician feedback about MBC, using symptom and alliance measures for MBC, training and presenter characteristics, and organizational considerations. Taken together, quantitative and qualitative findings highlight a gap in using alliance measures for MBC in applied settings. This study is the first to document a link between training perceptions and MBC uptake, underscoring the need to integrate frontline clinician perspectives in MBC efforts. Quantitative and qualitative findings indicate key topics that may be important to consider to facilitate MBC training and implementation efforts. (PsycInfo Database Record (c) 2026 APA, all rights reserved).