Psychotherapy最新文献

A number of studies have shown an association between therapist skills (particularly insight skills) and the working alliance, but few studies have examined the directionality of this relationship. In addition, studies have used either the client or therapist report of the working alliance rather than a dyadic perspective. Thus, we examined whether (a) dyadic insight skills are indirectly related to client outcome through the working alliance and (b) the dyadic working alliance is indirectly related to client outcome through insight skills. The dyadic working alliance was measured as a latent, dyadic average of both the client and therapists' reports of the working alliance. Therapist use of insight skills was operationalized via the use of skills such as interpretations, immediacies, challenges, and disclosures of insight. We used dynamic structural equation modeling to analyze longitudinal data in long-term, psychodynamic treatment. Results indicated that at the within-client level, the use of insight skills was associated with the working alliance in the next session, and the working alliance was associated with therapist use of insight skills in the next session; however, there were no mediation effects. However, at the between-client level, the pathway from working alliance at T-1 to therapist use of insight skills at T-2 to client outcome at T-3 was significant but only for clients in longer term treatments. Findings reveal the importance of the working alliance as a signal for therapists to use insight skills for client improvement in long-term, psychodynamic therapy. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

We investigated insecure attachment in relation to how actively romantic partners expect to participate in couple therapy (role expectations for self and partner) and, consequently, how much they expect to benefit from doing so (outcome expectations). Specifically, we used the mediated actor-partner interdependence model (Ledermann et al., 2011) with archived data from 297 heterosexual couples in a research-practice network (L. N. Johnson et al., 2017) who completed the Experiences in Close Relationships Scale-Short Form (Wei et al., 2007) and the Expectations and Preferences Scales for Couple Therapy (Friedlander, Muetzelfeld, et al., 2019) before their first session. Results showed acceptable model fit and a complex, dynamic interplay between gender, anxious, and avoidant attachment to partner, and pretherapy role and outcome expectations. For example, both members of the couple had lower expectations for the participation of partners who reported higher levels of attachment avoidance. Women with higher attachment anxiety also had lower role expectations for their male partners, as well as more negative outcome expectations. Whereas men with higher avoidant attachment reported lower expectations for their own role in the therapeutic process, highly anxious men expected their relationship to improve due to their own participation in the process rather than due to their partner's participation. Taken together, these results suggest that when romantic partners' interactions or descriptions of one another's behavior in the first session suggest a high level of attachment insecurity, particularly high avoidance, therapists should explain how their joint, active participation in the therapeutic process can help improve their relationship. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The objective of this study was to examine the experiences and expertise of Black mental health professionals (BMHPs) who work with Black racial trauma across the lifespan. Authors conducted a qualitative study with a critical-ideological paradigm as the methodology of this study. Twenty-five BMHPs (psychologists and counselors) were interviewed about their experiences working with Black clients suffering from racial trauma. Four superordinate themes were identified in the analysis of the data describing (a) how BMHPs define racial trauma and the effects they see racial trauma having on Black persons, (b) how BMHPs work to alleviate the symptoms of racial trauma, (c) the toll that working with racial trauma takes on their own well-being as BMHPs, and (d) ways BMHPs engage in restorative practices in order to continue to engage in the work of healing within the Black community. BMHPs report a strong sense of calling to work with Black persons suffering from racial trauma. They also report joy in their work, yet the complexity of working with racial trauma can be emotionally exhausting. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

To be responsive to the growing mental health inequities in our communities, we must move beyond incremental changes to our graduate training to bolder, more transformative changes. Such efforts must move beyond targeting our academic, internship, and postdoctoral programs and instead focus on critiquing our accreditation process. Without transformation of accreditation and other macrostructural dynamics in psychology, our training programs will continue to perpetuate the status quo and limit the ability of graduate trainees to adequately address mental health disparities. The purpose of this article is to call upon regulatory entities, such as the American Psychological Association Commission on Accreditation, to consider shifting training within applied doctoral programs from individual and cultural diversity competencies to a structural competency framework. Redefining this competency using structural perspectives will acknowledge the power, privilege, and oppression inherent within institutions, policies, and structures and better prepare psychology training programs to address the root causes of health inequities. Recommendations for change will be guided by the work of Metzl and Hansen (2014) on structural competencies and focus on the profession-wide and discipline-specific competencies required by the Commission on Accreditation. Barriers to change will also be examined, along with suggestions for resistance and reimagining of the accreditation process and our graduate training. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The present article aims to provide a pathway for trainers to expand and transform queer-affirmative psychotherapy practice to be more inclusive of queer groups that are underdiscussed in research and misunderstood in therapy settings, namely, people who are asexual, aromantic, and polyamorist. The article begins by outlining findings from a small but growing body of literature focusing on people who identify as asexual, aromantic, and polyamorist, which suggests that these populations face unique challenges and forms of discrimination when navigating their relationships, identity, and community. At the same time, these groups also report negative experiences of psychotherapy, including ignorance, minimization, and lack of understanding empathy on part of therapists. Such gaps may be bridged through cultural and structural changes in the way in which queer-affirmative psychotherapy models are disseminated in training contexts. Building upon models of queer-affirmative psychotherapy, critical theory, and queer theory, the article proposes steps that trainers may take to encourage students to expand their queer-affirmative practice so that it is more inclusive of and responsive to the experiences of asexual, aromantic, and polyamorist populations. The steps involve (a) cultivating criticality among trainees, (b) holding space for "not knowing," (c) providing diverse case examples, and (d) underlining advocacy as central and necessary to queer-affirmative practice. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

To investigate the perceptions of ex-romantic partners regarding the extent to which and ways in which psychotherapy facilitates coping with the consequences of the dissolution of past relationships, a multipart survey (Representations of Past Significant Others) that included Likert-type, multiple-choice, and open-ended questions about the ways in which individuals remember a past significant relationship and the ways in which they have moved toward closure from that relationship was disseminated via social media and networking. An attachment status measure (Experience in Close Relationship Scale-Short Form) was also administered. A total of 1,846 respondents, mean age 30.6 and predominantly White, heterosexual, female, and from the United States, completed the survey, 74.6% of whom attended psychotherapy post breakup. On average, respondents who engaged in therapy following their breakup found it to be moderately to very helpful; younger respondents, those in longer term relationships, and those with higher scores on the Experience in Close Relationship Scale-Short Form Anxiety subscale evaluated the helpfulness of therapy more highly. Multiple clinical interventions were perceived as helpful in coping with romantic breakups, including normalizing respondents' feelings about their experience, encouraging them to be more aware of their feelings, encouraging them to move forward with their lives, reminding them of their strengths, exploring the story of the relationship and the breakup, and challenging their self-critical thoughts or feelings. Understanding who is best served by postbreakup therapy and the specific interventions, psychotherapeutic and otherwise, that move individuals toward closure may facilitate therapists' efforts to help with this common source of client distress. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Psychotherapy outcome research mainly focuses on scale-level changes and constructs that were developed using cross-sectional statistical analysis, possibly concealing important findings on the level of single items, and limiting the clinical utility of outcome scales. Our goal was to explore changes in symptoms, interpersonal problems, and level of functioning in everyday life and to establish groups of items with similar rates of change that could be used to form more coherent targets for measuring different therapeutic outcomes. Triangulated maximally filtered graphs were used to model the network structure of the Outcome Questionnaire-45 in a data set of N = 12,075 university counseling center patients. Dynamic exploratory graph analysis was used to establish communities of items with similar rates of change. Five item communities (anxiety, hopelessness, interpersonal problems, well-being, and work impairment) were found. Compared to the original Outcome Questionnaire-45 subscales, they showed better fit to the data. The "hopelessness" community, which describes the extent of a patient's demoralization before the start of therapy, had a significantly higher rate of change compared to other communities. The discerned item communities provide clinicians with theoretically grounded, precise targets for outcome tracking, thereby enhancing the responsiveness and adaptability of treatment interventions to individual client trajectories. Such granularity enriches our understanding of therapeutic change, with direct implications for tailoring intervention strategies to maximize early therapeutic gains and sustain long-term recovery. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Researchers have historically focused on understanding therapist multicultural competency and orientation through client self-report measures and behavioral coding. While client perceptions of therapist cultural competency and multicultural orientation and behavioral coding are important, reliance on these methods limits therapists receiving systematic, scalable feedback on cultural opportunities within sessions. Prior research demonstrating the feasibility of automatically identifying topics of conversation in psychotherapy suggests that natural language processing (NLP) models could be trained to automatically identify when clients and therapists are talking about cultural concerns and could inform training and provision of rapid feedback to therapists. Utilizing 103,170 labeled talk turns from 188 psychotherapy sessions, we developed NLP models that recognized the discussion of cultural topics in psychotherapy (F-1 = 70.0; Spearman's ρ = 0.78, p < .001). We discuss implications for research and practice and applications for future NLP-based feedback tools. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The empirical and clinical literature emphasizes the importance of alliance ruptures, signaling therapeutic processes occurring within and between the partners of the therapeutic dyad. However, knowledge about the underlying regulatory processes that occur amid ruptures is scarce. Identifying the underlying physiological markers may shed light on these regulatory processes. The overarching goal of the present study was to explore physiological markers of withdrawal and confrontation ruptures, within the patient and the therapist. Given the little known on the subject, we used a single-case design (94 episodic segments) to explore biologically based regulatory processes in the face of a rupture, contrasting confrontation ruptures versus withdrawal ruptures versus control episodes (emotional and neutral episodes). Findings showed that the patient and the therapist had contrasting physiological responses to the ruptures, depending on the type. During withdrawal ruptures, the patient exhibited high regulation, while the therapist did not show a clear physiological reaction. During confrontation ruptures, the patient exhibited low regulation, while the therapist exhibited high regulation. The different physiological regulation processes at times of ruptures suggest that, in withdrawal, the patient relied on intrapersonal regulation, contrasting with the interpersonal regulation observed in confrontation ruptures. Findings remained robust after controlling for speech turns and 10,000 Monte Carlo permutations to assess chance-level results. These findings provide initial evidence for the link between arousal and behavior in ruptures, offering valuable psychoeducational material for therapists to improve their handling of these challenging moments. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Chronic pain and depression are highly prevalent and correlated in older adults. Acceptance and commitment therapy (ACT) and exercise have been shown to be effective for both conditions, mostly in Western literature. Little is known about integrating two approaches, particularly in Asian cultures and among less well-educated people. This article describes the iterative process of developing a culturally adapted ACT with exercise intervention for older Chinese with chronic pain and depressive symptoms. A multidisciplinary expert panel codesigned a culturally adapted ACT with exercise intervention, comprising a weekly 2-hr ACT and a 1½-hr exercise program for 8 weeks, focusing on six ACT core components and low-to-moderate intensity circuit-based resistance exercise. Its feasibility was tested through a mixed-methods, pretest-posttest design with 22 older Chinese experiencing chronic pain and depressive symptoms (M_age = 71.5 years, SD = 7.5, 86% female). Participants showed significant improvements in pain intensity, pain interference, pain self-efficacy, physical performance, pain acceptance, and committed action (all p < .05). We identified five themes to inform protocol revision: (1) contextualizing values, (2) utilizing experiential learning, (3) using culturally appropriate metaphors, (4) establishing linkage between ACT concepts and pain, and (5) promoting application through repetition and prompts. Incorporating these findings, the final protocol emphasized three core ACT components and one set of physical exercises. This is the first study demonstrating the feasibility of a culturally adapted, person-centered tailoring ACT with exercise intervention for improving pain-related outcomes and mental wellness among older Chinese. (PsycInfo Database Record (c) 2024 APA, all rights reserved).