Psychotherapy最新文献

We aimed to investigate prospective psychotherapists' bias in assessing their own facilitative interpersonal skills (FIS) and predictors of high self-assessments. In this cross-sectional observational study, we examined 132 psychology students and trainee psychotherapists. Therapists' demographic variables and self-concepts were assessed through self-report questionnaires, and their therapeutic skills were assessed with the German version of the "FIS" task. A truth-and-bias model approach was applied in three different hierarchical linear models to test self-assessment bias of FIS, and to identify factors associated with overly positive self-assessments of therapeutic skills. Significantly higher self-assessments of skills were found in comparison to observer ratings for overall FIS and for the FIS dimensions hope, emotional expression, warmth, acceptance, and understanding, empathy, alliance bond capacity, and rupture-repair responsiveness. Despite this discrepancy, there was a significant congruence between self- and observer ratings. A greater self-assessed ego-strength and attractiveness were associated with self-assessments of skills that were higher than the observer-rated average. Age, gender, experience, and other self-concept variables showed no significant association with self-assessments. This present study demonstrates self-assessment bias in prospective therapists. However, when participants rated their own FIS to be high, observers also tended to rate participants' skills higher. Especially therapists who generally feel more confident and attractive tend to estimate themselves positively. Supervisors and trainees should be aware of the ubiquity of self-assessment bias. Future research is necessary to test the effect of self-assessment bias on patient outcomes and process variables. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Emotional processing interventions for trauma and psychological conflicts are underutilized. Lack of adequate training in emotional processing techniques and therapists' lack of confidence in utilizing such interventions are barriers to implementation. We developed and tested an experiential training to improve trainees' performance in a set of transtheoretical emotional processing skills: eliciting patient disclosure of difficult experiences, responding to defenses against disclosure, and eliciting adaptive emotions. Mental health trainees (N = 102) were randomized to experiential or standard training, both of which presented a 1-hr individual session administered remotely. Before and after training and at 5-week follow-up, trainees were videorecorded as they responded to videos of challenging therapy situations, and responses were coded for demonstrated skill. Trainees also completed measures of therapeutic self-efficacy, anxiety, and depression at baseline and follow-up. Repeated-measures analysis of variance indicated all three skills increased from pre- to posttraining for both conditions, which were maintained at follow-up. Importantly, experiential training led to greater improvements than standard training in the skills of eliciting disclosure (η² = .05, p = .03), responding to defenses (η² = .04, p = .05), and encouraging adaptive emotions (η² = .23, p < .001) at posttraining, and the training benefits for eliciting disclosure were maintained at follow-up. Both conditions led to improved self-efficacy. Trainees' anxiety decreased in the standard training, but not in the experiential. One session of experiential training improved trainees' emotional processing therapy skills more than didactic training, although more training and practice likely are needed to yield longer lasting skills. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

It is generally assumed that psychodynamic therapy and cognitive behavioral therapy (CBT) differ in terms of applied techniques and processes. To date, however, little is known about whether and how such differences can actually be observed at a basic linguistic level and in what the two treatment approaches differ most strongly (i.e., how psychodynamic and CBT therapists differ in what they actually say word-by-word in therapy sessions). Building on theoretical models and previous research that used observer ratings, we formulated specific hypotheses regarding which word categories psychodynamic and CBT therapists who treat patients with an eating disorder should differ in. To investigate these hypotheses, we used verbatim transcripts from 297 therapy sessions of a randomized controlled trial in which patients with anorexia nervosa (n = 88) received either focal psychodynamic therapy (FPT) or CBT. These transcripts were then examined using computerized quantitative text analysis. In line with our hypotheses, we found that CBT therapists overall spoke more than their FPT counterparts and that they used more words related to eating. Also in line with our hypotheses, FPT therapists used more words related to social processes. Contrary to our expectations, CBT therapists did not show a stronger focus on the future but talked more about emotions than FPT therapists. The latter effect, however, appears to be driven by a stronger focus on positive emotions. These findings suggest that computerized quantitative text analysis can differentiate meaningful language characteristics of CBT and FPT on spoken-word level and that it holds potential as a tool for researchers and therapists. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Intensive short-term dynamic psychotherapy (ISTDP) is theorized to reduce negative affect by challenging patients' defense mechanisms so that they can experience and work through attachment-trauma-related emotions. While ISTDP has been shown to decrease depressive symptoms in single treatment-resistant depression (TRD), it has not been established whether negative affect and emotional repression are reduced, as theorized. Next to depressive symptoms, this retrospectively registered (https://osf.io/v46gy) randomized controlled trial, therefore, examined the effects of ISTDP on emotional repression and negative affect in adults with TRD. Eighty-six adults with major depressive disorder, who had not responded to at least one trial of antidepressants were randomized to 20 sessions of ISTDP (N = 43) or a waitlist control condition (N = 43). Mixed-effect models on the intention-to-treat sample showed that compared to the control condition, ISTDP resulted in significantly lower posttreatment levels of depressive symptoms (d = -1.73), emotional repression (d = -1.91), and negative affect (d = -1.45). Similarly, ISTDP resulted in significantly lower levels of depressive symptoms (d = -2.67), emotional repression (d = -2.69), and negative affect (d = -1.85) at the 3-month follow-up. These results support the evidence base of ISTDP by showing that it can decrease depressive symptoms, emotional repression, and negative affect in TRD. Future studies should assess whether these effects are specific to ISTDP. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

We draw recommendations and conclusions from the articles presented in this special issue and the companion special section in Psychotherapy Research on evidence-based therapist skills and methods. For distal (end-of-treatment) outcome, 10 skills/methods were judged to be demonstrably effective (affirmation/validation, paradoxical interventions, homework, routine outcome monitoring, strength-based methods, emotional regulation, imagery rehearsal therapy and exposure relaxation and rescripting therapy for nightmares, meditation/mindfulness/acceptance, behavioral activation, cognitive restructuring) and four were probably effective (rupture repair, role induction, collaborative assessment methods, chairwork). For intermediate (postsession or midtreatment) outcome, one method was judged to be demonstrably effective (cognitive-experiential dreamwork) and two methods probably effective (paradoxical interventions, homework). For immediate (in-session) outcomes, five skills/methods were judged to be probably effective (in-dialog silences, extended silences, role induction, strength-based methods, and emotion regulation). For the rest of the immediate, intermediate, or distal outcomes for skills/methods, there was either no or insufficient research available upon which to base judgments. Possible harmful effects, diversity considerations, and research limitations are summarized. The article ends with training implications, therapeutic practices, and the formal conclusions of the interorganizational Task Force on Psychotherapy Skills and Methods that Work. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

This article introduces the special issue of Psychotherapy on evidence-based skills and methods and concomitantly, outlines the purposes and processes of the Interorganizational Task Force that guided the work. We provide the rationale for reviewing psychotherapy skills and methods, define and contrast skills and methods with other components of psychotherapy, describe how to assess skills, methods, and outcomes (immediate in-session, intermediate, and distal), how to link skills and methods with outcomes, and how to summarize the extant research on those skills and methods. Finally, we describe how the research reviews of skills and methods lead to training implications and therapeutic practices. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The present study examines (a) the unique effects of chairwork on emotional process and intervention outcomes across treatments in the context of individual psychotherapy and (b) how these effects compare to other treatment interventions. Based on the appropriateness of the data available, meta-analyses with estimated effect sizes and narrative syntheses were conducted for psychotherapy process as well as symptom outcomes. Single-session chairwork was found to be more effective in deepening client experiencing than empathic responding (d = .90), although it may have an effectiveness similar to other interventions for facilitating emotional arousal or shifting the credibility of core beliefs. A single session of chairwork also has noteworthy pre-to-post symptom change (d = 1.73), although these improvements may be comparable to other methods of intervention (d = .02). However, when chairwork was used multiple times over the course of a treatment, it accumulated a meaningful effect (d = .40) compared to treatments that did not use chairwork. Therapeutic orientation emerged as a potential moderator. Incorporating chairwork into treatments may bolster process and intervention outcomes. We conclude the article with training implications and therapeutic practices. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

There is research evidence, from both qualitative and quantitative studies, that silences in psychotherapy have established associations with good and poor outcomes that include and extend beyond symptom measures to processes such as insight, symbolization, and disengagement. Research also has demonstrated that therapists attend to clients' silences, seeking to comprehend the processes therein and intentionally support productive silent processes. This chapter synthesizes this research and examines features of silence processes to provide psychotherapists with the skills to differentiate the functions of both productive and obstructive forms of pausing. It includes a review of 33 quantitative and qualitative studies on silences in individual psychotherapy (from 309 clients and 209 therapists). Our qualitative and integrative meta-analytic evidence indicated that it enhanced their ability to intervene responsively and enhance therapy outcomes when psychotherapists' responded strategically to the specific functions of silences. We consider research limitations, training implications, and therapeutic practices based on the research evidence. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Role induction is a pantheoretical method that can be used in the initial phase of psychotherapy to prepare patients for treatment. The purpose of this meta-analysis was to examine the effects of role induction on treatment dropout, and immediate, mid-, and posttreatment outcomes for adult individual psychotherapy patients. A total of 17 studies were identified that met all inclusion criteria. Data from these studies indicate that role induction has a positive impact on reducing premature termination (k = 15, OR = 1.64, p = .03, I² = 56.39) and improving immediate within-session outcomes (k = 8, d = 0.64, p < .01, I² = 88.80) and posttreatment outcomes (k = 8, d = 0.33, p < .01, I² = 39.89). However, role induction did not show a significant impact on midtreatment outcomes (k = 5, d = 0.26, p = .30, I² = 71.03). Results from moderator analyses are also presented. Training implications and therapeutic practices based on this research are also discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Psychotherapists provide at least some advice, suggestions, and recommendations (ASR) in most treatment approaches. We define ASR, offer clinical examples, and review the research evidence for the immediate in-session, immediate delayed, and intermediate effects of ASR, as well as for the moderators of these effects in individual psychotherapy. In seven studies with 327 clients and 131 therapists, we found evidence of neutral immediate in-session outcomes (e.g., client experiencing levels), neutral immediate delayed outcomes (e.g., client-rated helpfulness during postsession videotape reviews), and positive intermediate outcomes (e.g., implementation of recommendations as rated in subsequent sessions) for ASR. These differences may be related to methodological variations in studies in addition to the different timing of the outcome measurement. In terms of moderators, there is some evidence that the working alliance, client collaboration prior to the ASR, content of the ASR, and therapist and client attachment styles moderate the effects of immediate in-session outcomes, and that type, difficulty, and therapist influence moderate the effects of intermediate outcomes of ASR. We conclude with research limitations, training implications, and therapeutic practices related to ASR. (PsycInfo Database Record (c) 2023 APA, all rights reserved).