Psychotherapy最新文献

Psychotherapy is a well-established and effective treatment for various psychiatric problems, but a substantial proportion of patients do not benefit from it, and many terminate treatment prematurely. Previous studies suggest that therapist dissatisfaction may play a pivotal role in premature treatment termination. This study, therefore, aimed to investigate therapist factors that may contribute to less-than-optimal results and dropout. Data were collected through a survey of patients (n = 736) with the experience of previous unsuccessful psychotherapy treatments. Based on prior research, the survey covered 13 therapist behaviors and traits, such as being unstructured or unengaged. The most common therapist factor that patients associated with treatment failure was poor assessment/understanding (86.7%), followed by inflexibility (71.7%) and poor knowledge (70.1%). Furthermore, this study identified four novel therapist-related factors: breaking the treatment contract, inappropriate sexual behaviors or comments, using non-conventional methods, and dominating behaviors. Overall, this study highlights the significance of therapist-related factors in premature treatment termination and treatment failure, shedding light on the crucial role therapists play in the therapeutic process. Understanding these factors is essential for improving psychotherapy outcomes and reducing dropout rates. Further investigations are needed to explore the impact of these therapist behaviors on treatment outcomes and to develop strategies for enhancing therapist competencies and skills to foster a more effective therapeutic alliance. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

There is a large body of research exploring therapeutic effectiveness for racially or ethnically minoritized college students. Prior literature highlights the unique mental health and academic challenges faced by Native American students in higher education; however, there is a paucity of research examining the effectiveness of counseling for Native American college students. The present study examined the effectiveness of counseling on psychological and academic distress among Native American college students, comparing their initial distress and rate of change to White students in counseling. Using naturalistic data from a large practice-research network spanning 2015-2019, we employed hierarchical linear modeling to evaluate the effect of race on psychological distress (N = 9,621) and academic distress (N = 9,643) scores during treatment. Results revealed that all clients demonstrated a significant decrease in both types of distress over the course of treatment. Native American and White clients presented to counseling with similar levels of psychological distress. However, Native American clients experienced more change and at a faster rate on psychological distress symptoms compared to White clients. On academic distress, Native American clients began and concluded counseling with higher levels of distress while experiencing a similar amount of change at a similar rate in their reduction of academic distress over the course of treatment. The study findings provide unique insight on the outcomes of treatment-seeking Native students by demonstrating a significant positive response to counseling, as well as novel comparisons between Native and White students receiving services within college counseling settings. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Psychotherapy is an interpersonal process of collaboration toward specified treatment goals. The therapeutic alliance is well established as an important factor of psychotherapeutic change. However, the experience of distress in social interactions, commonly referred to as interpersonal problems, might be interfering with the collaborative process during psychotherapy. This study systematically reviews the literature and obtains an estimate of the relationship between pretreatment interpersonal problems and the quality of the therapeutic alliance. Overall, 27 studies with 48 correlation coefficients were included in the final analysis. Due to the nested structure of the data, a three-level meta-analytic approach with a restricted maximum likelihood estimator was applied. Alliance assessment phase, alliance rater, alliance measure instrument, and treatment type were tested as potential moderators. Heterogeneity and publication bias test were performed. The meta-analysis showed a small, but significant negative relationship between interpersonal problems at the beginning of psychotherapy and subsequent therapeutic alliance (r = -.12, SE = .02, 95% CI [-.16, -.08], p < .001, d = -.27). Only alliance assessment phase accounted for significant variability. There were no indications for a substantial publication bias. Interpersonal problems of patients before psychotherapy are a robust predictor for lower therapeutic alliance quality, albeit a small effect size. Consequently, patients who experience interpersonal problems may face greater challenges in developing a strong alliance with their therapists, especially in early stages of the treatment. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

As the popularity of dialectical behavior therapy (DBT) grows, so does its use with increasingly diverse groups of clients. In this article, we demonstrate that DBT in its standard form can incorporate the sequelae of oppression as a target of treatment by providing clients with skills to identify oppression and its impact while responding effectively. To support the use of DBT with individuals experiencing emotion/behavior dysregulation and oppression, we review how each of the primary strategies of DBT can be used within the context of oppression. Specifically, we discuss how dialectical philosophy, the acceptance/change dialectic, communication strategies, and case management strategies can be viewed through an oppression lens. A brief review of DBT research with historically oppressed populations and common pitfalls in treating oppressed individuals is presented. As research in examining and adapting DBT for minoritized groups continues to catch up to clinical need, guidance is presented here for researchers and clinicians interested in using this empirically supported treatment in communities that experience oppression. (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).

Trainees often express anxieties when working with clients from different sociocultural backgrounds. Group supervision can provide a space to address such concerns, including managing culturally related countertransference and understanding sociocultural factors in issues faced by clients. This process requires critical consciousness and discussion of trainees' and clients' cultural identities. This study built on research highlighting the positive role of cultural humility in individual supervision and group therapy to examine cultural humility in group supervision and its contribution to trainees' self-efficacy in adapting therapy and managing relationship conflicts with a range of clients (i.e., cultural responsiveness self-efficacy), via sociocultural awareness and minimal cultural concealment about themselves and their clients. Ninety-one master's level counseling trainees in Hong Kong from 18 supervision groups in two training programs completed measures of cultural humility, cultural concealment, sociocultural awareness, and cultural responsiveness self-efficacy. Multilevel modeling indicated that, at the within-trainee level, higher group cultural humility was associated with higher sociocultural awareness and lower cultural concealment about themselves and their clients. Greater sociocultural awareness, but not cultural concealment, was, in turn, linked to higher cultural responsiveness self-efficacy. At the between-trainee level, higher group cultural humility correlated with lower trainee cultural concealment, but not sociocultural awareness, which was associated with cultural responsiveness self-efficacy, although no mediation was observed. This study underscores the value of cultural humility in the context of group supervision. Implications for multicultural group supervision are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Cultural humility is an oft-studied construct in psychotherapy and supervision and, as such, has multiple definitions and frameworks and is frequently contextualized as the organizing pillar of the multicultural orientation framework (MCO; alongside cultural comfort and cultural opportunities; Davis et al., 2018; Owen, 2013). Many definitions of cultural humility emphasize a high level of self-awareness, openness to feedback, empathy, and curiosity toward others' cultural experiences (Davis et al., 2018; Foronda et al., 2016; Hook et al., 2013; Zhang et al., 2022). Despite empirical evidence linking cultural humility processes, and MCO more generally, to indicators of successful psychotherapy and supervision (e.g., Davis et al., 2018; Wilcox, Drinane, et al., 2022), little guidance exists for how supervisors may assess and foster their supervisees' cultural humility. Drawing from the literature, we delineate what we see as effective pedagogy and assessment of the key ingredients of cultural humility and provide recommendations for how supervisors can use the supervisory relationship to cultivate in their supervisees each of the necessary ingredients. Given cultural humility's key role in the MCO framework, we discuss how the ingredients required for cultural humility lay the groundwork for cultural comfort and cultural opportunities. Supervision vignettes and additional resources for supervisors are included. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

There is a rich history of psychological movements that call upon the field to collaborate with clients to both acknowledge and resist oppression, as well as an increasing emphasis in professional guidelines on conceptualizing clients with attention to the role of the social and physical environment, to contemporary experience with power, privilege, and oppression, and to institutional barriers and related disparities. These calls indicate the need for psychological case conceptualization to move beyond preconceived assessments of which aspects of clients' identities are salient to them, to engage with clients' sociocultural identities as situated within systems of power and oppression, and to engage in advocacy to improve clients' socioenvironmental contexts and to challenge structural oppression. In this article, we attend to the foundational contributions of Black psychology, intersectionality, liberation psychology, Indigenous healing, and radical healing for using case conceptualization to guide structurally responsive and impactful treatment and advocacy. We then present a case example drawn from a composite of clinical encounters that captures client distress interwoven with structural forces such as addiction stigma, intersecting classism and sexism, White privilege, and caregiver leave policies. To demonstrate how to integrate structural forces with theory, we present how this case would be conceptualized utilizing psychodynamic frameworks infused with attention to the ways in which structural forces shape and perpetuate the client's distress. To move from naming to integrating structural competency in case conceptualization, psychotherapy training must address how structural forces shape how client distress develops and is maintained and necessitates advocacy outside of the session. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The collaborative relationship between a client and therapist, known as the therapeutic alliance, plays an important part in promoting engagement and symptom improvement in adolescent psychotherapy. However, research indicates that alliance strains, called ruptures, are common among this age group, emphasizing the importance of addressing and resolving them for enhanced engagement and better outcomes. Despite this, there is a dearth of age-specific guidelines for effectively fostering a positive alliance and repairing these ruptures. This review examines existing literature to (a) summarize the current understanding of alliance formation in youth psychotherapy, particularly considering the distinct characteristics of working with adolescents, and (b) provide evidence-based recommendations to assist youth therapists in building strong alliances and effectively addressing alliance ruptures with this age group. Existing evidence indicates that while guidance designed for adult therapy can be beneficial, working with adolescents poses unique challenges. These include resistance to treatment, engagement in risky behaviors, confidentiality issues, and parental involvement, which can strain the therapeutic relationship. This emphasizes the importance for youth therapists to understand the unique challenges and developmental stages adolescents face and to adapt their approach accordingly. By doing so, therapists can effectively address the needs of adolescents, fostering a strong alliance and handling any ruptures that may arise. Despite being a relatively new area of study with its inherent limitations, this review underscores the critical role of alliance research in improving therapy for adolescents and guiding the training of therapists who work with this age group. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Meta-analysis has found a significant relation between rupture-repair and client outcome (Eubanks et al., 2018). Rupture-repair processes may be particularly important in psychotherapy for pregnancy loss wherein ruptures related to client feelings of shame and inadequacy, the societal invalidation of perinatal grief, and reenactments in the therapy relationship of early attachment experiences have been theorized to be common and important events (Markin, 2024). Thus, it is important to understand what occurs on a microlevel during the process of therapy to ultimately explain the rupture resolution (RR) and treatment outcome association. In particular, while both the therapist and client are believed to contribute to ruptures and to their repair (Safran & Muran, 2000), little is known about how therapist contributions impact rupture events, rupture resolution, and treatment progress. Further, client reflective functioning (RF) may represent a set of capacities that contribute to and are increased by rupture resolution yet vary depending on the role of the therapist in the rupture. The current investigation examined how observer-rated therapist contribution to ruptures and client RF were related to rupture events, rupture resolution, and client-reported symptom change and session quality over 22 sessions of psychodynamic therapy for pregnancy after loss. Therapist contribution to ruptures predicted rupture significance, high and steady within-session client RF scores, and symptom change. Client RF and rupture resolution predicted symptom change differently, often depending on type of symptom. Importantly, client RF and rupture resolution may predict successful outcomes through ameliorating commonly reported symptoms during pregnancies after loss. (PsycInfo Database Record (c) 2024 APA, all rights reserved).