Psychotherapy最新文献

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).

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).

The facilitative interpersonal skills (FIS) task is a performance-based task designed to assess clinicians' capacity for facilitating a collaborative relationship. Performance on FIS is a robust clinician-level predictor of treatment outcomes. However, the FIS task has limited scalability because human rating of FIS requires specialized training and is time-intensive. We aimed to catalyze a "big needle jump" by developing an artificial intelligence- (AI-) based automated FIS measurement that captures all behavioral audiovisual markers available to human FIS raters. A total of 956 response clips were collected from 78 mental health clinicians. Three human raters rated the eight FIS subscales and reached sufficient interrater reliability (intraclass correlation based on three raters [ICC3k] for overall FIS = 0.85). We extracted text-, audio-, and video-based features and applied multimodal modeling (multilayer perceptron with a single hidden layer) to predict overall FIS and eight FIS subscales rated along a 1-5 scale continuum. We conducted 10-fold cross-validation analyses. For overall FIS, we reached moderate size relationships with the human-based ratings (Spearman's ρ = .50). Performance for subscales was variable (Spearman's ρ from .30 to .61). Inclusion of audio and video modalities improved the accuracy of the model, especially for the Emotional Expression and Verbal Fluency subscales. All three modalities contributed to the prediction performance, with text-based features contributing relatively most. Our multimodal model performed better than previously published unimodal models on the overall FIS and some FIS subscales. If confirmed in external validation studies, this AI-based FIS measurement may be used for the development of feedback tools for more targeted training, supervision, and deliberate practice. (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).

Despite the availability of evidence-based psychosocial and pharmacologic interventions for mental health concerns, access to care remains suboptimal. We present a time-efficient mental health treatment program designed to improve overall community access to evidence-based care. Quality of care within the time-efficient model was prioritized by focusing on a multifaceted program of evidence-based interventions and facilitating connections to long-term care when needed. We present the results of a proof-of-concept open trial that indicates that access to care can be improved while maintaining quality mental health services. The Time-Efficient, Evidence-Based, Accessible, Multidisciplinary approach includes time-limited care provided by a team of psychotherapists, psychiatrists, nurse practitioners, and case managers working in pods, supported by measurement-based care, to develop individualized treatment plans. We used data from the electronic health record to evaluate (a) access to care, (b) engagement, and (c) treatment outcomes for an initial sample of 1,726 patients. Patients waited on average 17 days to see a therapist and 20 days to see a psychopharmacologist. Patients received on average 10 sessions of psychotherapy and four medication management sessions. Fifty-seven percent remained in treatment for at least 3 months. Patients demonstrated large improvements in depression (d = 1.18) and anxiety (d = 1.20) with small to moderate effects for improvements in functioning (d = 0.40). By capitalizing on a package of evidence-based interventions delivered with equitable time limits, the Time-Efficient, Evidence-Based, Accessible, Multidisciplinary clinic demonstrates initial access while yielding good engagement in services and moderate to large treatment effects. (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).

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).

A key mechanism of psychopathology and change proposed by the theory of interpersonal reconstructive therapy (IRT; Benjamin, 2003, 2018) is termed the "gift of love" (GOL). The GOL hypothesis is that wishes to receive love and acceptance from specific internalized attachment figures shape and maintain problem patterns and their associated symptoms for many patients across a wide range of psychopathology. According to IRT theory, optimal intervention is defined by therapist alignment, or "adherence," to a core algorithm of principles that are tailored individually and bring awareness to (a) attachment-based yearnings for love and acceptance from internalized figures and (b) how those yearnings shape and motivate current problems and symptoms. The method then seeks to enhance choice about those relationships and their attendant feelings, hopes, and fears. The study sample includes 30 patients, referred while receiving inpatient treatment and followed on an outpatient basis, with complex, high-acuity clinical needs (i.e., histories of multiple psychiatric hospitalizations, recurrent suicidality, ineffectiveness of prior treatment, and significant personality pathology). Reliable measures were developed to track therapist adherence to IRT principles, as well as patient stages of change coming to terms with the GOL. IRT adherence was associated with retention, reduced depression and anxiety, and improved self-treatment. Mediation analyses support the proposition that change in IRT is contingent upon patient progress at grieving the losses and associated wishes linked to attachment figures. Implications for theory-guided research and practice at the level of underlying principles are discussed. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Operationalizing technical flexibility as session-to-session adjustments in therapist techniques, this study explored the context-dependent aspects of its effects on treatment outcomes. Specifically, we focused on how session-to-session adjustments in therapist techniques have different influences on subsequent client outcomes depending on the therapist-rated quality of the previous session. We used data collected from 3,970 sessions conducted by 17 doctoral student therapists in a university clinic, where 132 adult community clients received individual psychodynamic psychotherapy. The extents of session-to-session technique adjustment were measured by Euclidean distance scores representing the difference between techniques (i.e., explore, insight, and action skills) used in two adjacent sessions. Dynamic structural equation modeling was used to examine temporal relationships among client-rated therapist technical adjustments, therapist-rated previous session quality, and client functioning. When therapists evaluated their previous sessions as lower than usual in quality, moderate adjustments were associated with worse-than-usual client functioning in the current week, compared to sticking to previous techniques or making significant adjustments. When the therapist-rated previous session quality as higher than usual, more technical adjustments from the previous sessions were associated with better current week client functioning. The implications and limitations of the present study were discussed. (PsycInfo Database Record (c) 2025 APA, all rights reserved).