Psychotherapy最新文献

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).

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).

Extensive research, including meta-analytic studies, has underscored the role of working alliance in influencing psychotherapy outcomes. However, far fewer studies and meta-analyses have delved into the predictors of working alliance quality. To synthesize the literature and highlight key predictors for alliance, the present study conducted a meta-analysis of predictors of subsequent working alliance. Drawing on 898 Pearson's r effects from 130 studies involving 12,449 clients and 2,840 therapists, a multilevel meta-analysis identified five major groups of factors that preceded alliance. Among client-related factors, client resource and readiness positively correlated with alliance, showing small and medium effect sizes, respectively (r = 0.18, 95% CI [0.12, 0.24], p < .001 and r = 0.34, 95% CI [0.25, 0.42], p < .001), while client distress negatively predicted alliance (small effect size, r = -0.14, 95% CI [-0.18, -0.11], p < .001). Regarding therapist-related factors, treatment execution showed a small effect size (r = 0.15, 95% CI [0.03, 0.28], p = .019), and rapport building contributed to alliance quality with a medium effect size (r = 0.39, 95% CI [0.31, 0.47], p < .001). The study revealed notable between-study heterogeneity and found several moderation effects. The meta-analytic effects remained robust across various sensitivity analyses. This study illuminates the significant roles of both clients and therapists in developing working alliance and discusses its implications, limitations, and future research directions. (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).

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) 2025 APA, all rights reserved).

The longstanding tension between psychology and religion/spirituality poses significant challenges for therapists who are themselves religious or spiritual, especially when integrating these dimensions into their professional practice. This study explored how trainees from diverse religious, spiritual, and cultural backgrounds navigate the intersection of their professional and religious identities within a culturally sensitive clinical psychology training program in Israel. Using qualitative thematic analysis of semistructured interviews with 30 of the program graduates-including Ultra-Orthodox Jews, Arab Muslims, Ethiopian Jews, immigrants from the former Soviet Union, and secular Jews-we identified four central tensions: the historical and contemporary attitudes of psychology toward religiosity and spirituality; religious society's view of the profession of psychology; questions related to spiritual and religious identity; and challenges with professional identity formation. The training program addresses these tensions by fostering "familiarity" through inclusion of spirituality and religion in the curriculum and a diverse faculty/student body. On this secure basis, the program encourages "productive discomfort" by having students sit with the tensions between their religious/spiritual identities and psychological perspectives. The findings offer valuable insights into how culturally sensitive training programs can support therapists in navigating these complexities, thereby enhancing spiritual and religious competence in psychotherapy. This study contributed to understanding the specific needs of therapists undergoing such training and underscores the importance of embracing spiritual and religious dimensions within mental health services and training. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Spiritual and religious competence in psychotherapy is increasingly recognized as essential for supporting patients facing religious and spiritual struggles, though there is a lack of reliable objective measures to evaluate clinician competence in this area. This study aimed to develop and provide preliminary validation for the Brief Spirituality/Religiosity Functional Competency Scale, an observational tool designed to assess functional spiritual/religious competencies, and to examine the relationship between these competencies and therapeutic alliance. Participants were 105 doctoral trainees enrolled in clinical or counseling psychology programs across the United States. Using data from objective-structured clinical examinations, we assessed the scale's internal consistency, interrater reliability, convergent and discriminant validity. The observational design evaluated participants' functional competencies during brief simulated clinical encounters. The scale demonstrated acceptable reliability and validity. While the overall competency score did not significantly predict therapeutic alliance or cultural humility, individual item analysis revealed that the "Help Explore Strengths" spiritual/religious competency and general advocacy skills significantly predicted stronger therapeutic alliance (R² = .10). Only advocacy skills significantly predicted cultural humility (R² = .10). Religious commitment was modestly correlated with both self- and expert-rated spiritual/religious competence but was not associated with simulated patient-rated therapeutic alliance or cultural humility. These results underscore the importance of assessing discrete demonstrated spiritual/religious competencies-rather than relying on global ratings or self-perceived religious commitment-to understand their unique contributions to therapeutic alliance. The scale shows promise for use in formative and summative assessments of clinician competence in spiritual and religious domains. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Latinos experience disproportionate rates of obesity and related conditions like type 2 diabetes, which are projected to increase (Mohebi et al., 2022). Standard interventions for these issues often fall short due to individual-focused approaches and the lack of culturally sensitive definitions of health that include emotional, physical, political, and social domains (Gutierrez Chavez et al., 2022; Ritchie et al., 2020). Multilevel and multidimensional research efforts, integrating social justice-informed orientations, psychotherapy science, and behavioral medicine, are crucial for addressing these health inequities (Asnaani, 2023; Collins et al., 2018; Rodriguez Espinosa & Verney, 2021). Additionally, critically analyzing researcher and participant roles is essential to avoid perpetuating systemic racism (Cook et al., 2023). This article highlights the need for a paradigm shift in psychotherapy research by (a) describing Latino families' eating patterns and coping strategies for emotional distress through focus groups in the community and (b) illustrating the process behind the community-partnered development of a culturally responsive mindfulness-based health intervention. Importantly, this research approach emphasizes liberation psychology theory in the exploration of structural influences affecting health (Martín-Baró, 1996). While mindfulness techniques are feasible in this population (Cotter & Jones, 2020), Latino communities may not be amenable to the current presentation of mainstream psychological science interventions. Our research paradigm informed the conceptualization of mindfulness techniques through both clinical science and critical lenses. Thus, this study argues for reconceptualizing the definition of a successful psychotherapy study to include community engagement and liberatory principles, making the potential for big needle jumps in addressing health inequities incalculable. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Longitudinal evidence indicates struggles with spirituality/religion (S/R; e.g., feeling distant or abandoned by God, guilty for not attaining standards of moral perfection, judged by one's family or community) may cause distress and hinder recovery from mental health challenges. However, research has not examined temporal associations between spiritual struggles and psychological distress in spiritually integrated psychotherapies (SIPs). In total, 175 practitioners of SIPs from 38 clinics and other settings in a practice-research network assessed these outcomes with 1,404 clients over the first 6 weeks of treatment (Time 1 [Weeks 1-2], Time 2 [Weeks 3-4], and Time 3 [Weeks 5-6]). In keeping with findings from other samples (e.g., Cowden et al., 2022, 2024; Currier et al., 2015, 2018), cross-lagged panel analyses across the three time points revealed spiritual struggles predicted clients' psychological distress at the next interval rather than vice versa. Specifically, whereas psychological distress was not predictive of later spiritual struggles, clients who were struggling with their S/R at Time 2 were generally more psychologically distressed at Time 3. Further, the positive prospective association between spiritual struggles at Time 1 and psychological distress at Time 3 was mediated by the severity of spiritual struggles at Time 2. In combination, these findings affirm spiritual struggles drive many clients' depression, anxiety, and other symptoms over the course of SIPs. As such, clinicians will ideally cultivate foundational knowledge and skills about the darker side of S/R that might prepare them to address their clients' spiritual struggles throughout the treatment process when clinically indicated. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Process and outcome studies focusing on antisocial traits (ANT) are limited (Van den Bosch et al., 2018), especially in nonforensic/nonoffender outpatient settings (Thylstrup & Hesse, 2016). ANT can impact outcomes through several mechanisms, such as treatment rejection, premature dropout, or poor alliance formation (Van den Bosch et al., 2018; Messina et al., 2002). In a prior study (Cersosimo, Hilsenroth, Bornstein, & Gold, 2022), we found that patient-rated alliance early in outpatient psychotherapy was negatively related to pretreatment ratings on Personality Assessment Inventory scales assessing ANT. The present study extends this work by examining ANT, alliance, and treatment readiness with outcome. We found that ANT, treatment rejection, and patient-rated alliance were significantly related to patient-rated outcome (n = 65). Regression analysis indicated that both ANT (β = -.29, p = .014; f² = 0.09) and treatment rejection (β = -.28, p = .019; f² = 0.09) were unique, negative, predictors of outcome, explaining 18% of the variance. Adding the significant, positive, patient-rated alliance to the model (β = .34, p = .003; f² = 0.13) increased explained variance to 25%. Subsequent analyses revealed that the negative impacts of treatment rejection on outcome occur separate from both ANT and alliance, while the negative impact of ANT on outcome is partially mediated by the positive effects of alliance (indirect effect = -.10, lower level confidence interval = -.208; upper level confidence interval = -.003). We discuss how early assessment of ANT and treatment readiness informs treatment planning. Limitations of the study and next steps for research are noted. (PsycInfo Database Record (c) 2025 APA, all rights reserved).