Psychotherapy最新文献

Despite the benefits of psychotherapy to improve mental health outcomes, therapy remains significantly underutilized among Black Americans. Yet, once therapy is initiated, Black clients experience mental health outcomes comparable to those in the general population, underscoring potential barriers to engagement. To address this gap, our qualitative study explored factors that contribute to client engagement throughout the therapeutic process, including core therapeutic skills related to therapist qualities, provider-client alliances, and nontherapeutic factors that shape the client experience. Using a qualitative hermeneutic phenomenological approach, semistructured qualitative interviews were conducted with past and current Black clients at a university-based training clinic about their experiences engaging in therapy. Data were analyzed through thematic analysis, and a codebook was developed to adequately capture patterns in perspectives across the interviews. Major themes, including therapist acknowledgment of cultural identity and perceived therapeutic collaboration, were emphasized as being integral in promoting engagement. Additionally, participants discussed factors that contributed to positive treatment experiences, including flexible procedures and accommodating clinic staff. These findings suggest that cultural acknowledgment, therapeutic collaboration, and a supportive clinic environment are essential to increasing Black clients' utilization of therapeutic services. Understanding the factors that increase accessibility and engagement for Black clients can lead to improved treatment outcomes. (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).

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).

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).

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).

Circle of Security (COS) interventions aim to improve parent-child relationships. Preliminary evidence of the effectiveness of COS interventions has been positive, but recent studies suggest mixed results that may be due to a lack of differentiation between different versions of COS interventions. This systematic review used a theory of change/program logic approach to summarize the evidence for COS interventions and to explore the conditions under which each protocol was most effective. A comprehensive systematic literature search was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for studies administering a verified COS intervention protocol with parents/caregivers of children aged 0-8 years. Studies were coded for study design, protocol type, sample characteristics, treatment fidelity, dose, risk of bias, and type of outcome. Nineteen eligible studies were included; seven were randomized controlled trials. Studies of the higher dose protocols (i.e., COS-Intensive, COS-Intensive-Revised Hybrid, COS-Perinatal Protocol) showed promising results across primary and secondary parent outcomes, longer term relationship and child outcomes, and clinical samples. Results showed mixed evidence for the efficacy of the more scalable COS-Parenting. Reviewing studies according to the theory of change/program logic suggested three sources of variability in COS-Parenting studies compared to the higher dose COS interventions that could impact outcome: treatment dose/strategies, sample type, and treatment fidelity. Differential effectiveness of COS interventions tested in seven randomized controlled trials, two nonrandomized controlled trials, and 10 single-arm trials suggests that different COS variants may be better suited to different target populations. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Rumination is a mental process characterized by the repetitive analysis of concerns without taking concrete or helpful action. It has been shown to be transdiagnostic, contributing to the maintenance and exacerbation of symptoms across various mental disorders, including obsessive-compulsive disorder (OCD). Historically conceptualized as part of the obsessional domain due to its repetitive and intrusive qualities, rumination is now better understood as a covert compulsion-one that reinforces the overimportance of otherwise normal, unwanted intrusions, particularly in the case of repugnant obsessions. Consequently, it is crucial for clinicians to frame rumination as a mental habit or behavior in which individuals with OCD attempt to understand the causes, meaning, and consequences of their thoughts. This unproductive and time-consuming process not only amplifies intrusive doubts but also worsens mood, placing individuals at high risk for comorbid depression. This article outlines how rumination fits within the cognitive-behavioral model of OCD and, more importantly, offers practical refinements to standard cognitive-behavioral therapy interventions, drawing from evidence-based strategies for OCD and related disorders as well as from behavioral activation. The aim is to better equip clinicians with tools to effectively target rumination in OCD, particularly in presentations involving repugnant obsessions. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Treating the suicidal patient is a risky, often emotionally exhausting process that strains the best therapist's capacity to maintain the primary focus of psychotherapy. When fear, desperation, and urgency to resolve the suicidal state become overwhelming, therapists and patients can get lost in protracted power struggles and crisis management (Plakun, 2001). Starting from the proposition that suicidal states are primarily driven by overwhelming affective experiences (Maltsberger, 2004), the authors expand upon an earlier clinical article (Fowler, 2013) to include new facets of interventions accompanied by clinical vignettes. Targeted research findings supporting these core interventions follow each vignette. Therapists are encouraged to flexibly shift among clinical interventions while carefully monitoring the emotional state and responsivity of the patient: (a) creating a sense of interpersonal safety in the therapy dyad; (b) coregulation of emotion utilizing mentalization-based therapy interventions (Bateman & Fonagy, 2016) and elements of therapeutic presence (Geller & Porges, 2014); (c) enhancing mentalizing by modeling curiosity about suicidal states of mind (Allen, 2011; Bateman & Fonagy, 2016); (d) identifying meaning(s) and pattern(s) that precipitate suicidal states; and (e) aiding the patient in fostering an enduring sense of trust. While informed by attachment theory, mentalization-based therapy, and polyvagal theory, these interventions are best conceptualized as common factors and can be utilized in conjunction with third-wave cognitive behavioral therapy, interpersonal, and integrative approaches. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Despite the evidence indicating that accommodating preferences leads to better outcomes, we currently know very little about what psychotherapists prefer to deliver and whether this matches patient preferences. This research aimed to understand the degree of mismatching between patients' preferences in psychotherapy and psychotherapists' preferred psychotherapy delivery in Chinese clinical contexts. We utilized three samples from two different Chinese clinical contexts. Study 1 consisted of two independent samples of patients (N = 301) and psychotherapists (N = 1,054). The Cooper-Norcross Inventory of Preferences patient and therapist versions were administered to assess preferences. In Study 2, a paired patient-psychotherapist sample (N_{psychotherapists} = 155, N_patients = 3,060) was used to replicate Study 1 findings. Results from both studies indicated two significant areas of mismatch. First, psychotherapists had a stronger preference for their patients to take the lead in psychotherapy when compared with lay patients (d = 0.74∼0.82). Second, psychotherapists showed a stronger preference for emotional intensity than patients (d = 0.57∼0.62). These differences were relatively consistent across psychotherapists' theoretical orientations and personal psychotherapy experiences, with some variation linked to psychotherapists' clinical experience. Psychotherapists' preferred delivery styles, as compared with patients' actual preferences, are consistent with psychotherapists' own preferences (as patients) and may reflect a false consensus bias. (PsycInfo Database Record (c) 2025 APA, all rights reserved).