Psychotherapy最新文献

[Correction Notice: An Erratum for this article was reported in Vol 60(3) of Psychotherapy (see record 2023-99100-002). In the article (https://doi.org/10.1037/ pst0000488), the number of included studies in Figure 2 omitted two studies that were added to the literature synthesis. Therefore, the following has been added to the Reports excluded box in Figure 2: A further two studies were added to the research synthesis by author knowledge. All versions of this article have been corrected.] This article reviews the evidence for between-session homework (BSH) in individual psychotherapy. Whereas previous reviews have demonstrated a positive association between-client compliance with BSH and distal treatment outcomes; here, we pay particular attention to therapist behaviors that may promote client engagement with BSH assessed as immediate (in-session) and intermediate (session-to-session) outcomes, and moderators of these effects. For our systematic review, we identified 25 studies with 1,304 clients and 118 therapists, mostly on cognitive behavioral therapy such as exposure-based treatments with depression and anxiety disorders. A box score approach was utilized to summarize findings. Results for immediate outcomes were mixed but neutral. Results for intermediate outcomes were positive. Presenting a convincing rationale, being flexible in collaboratively designing, planning, and reviewing homework tasks in accordance with the clients' goals, aligning BSH with the clients' takeaways from the session and providing a written summary of homework and rationale, are some therapist behaviors that can promote client engagement with BSH. We conclude with research limitations, training implications, and therapeutic practices. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Research shows the disruptive effects of early maltreatment on the autonomic nervous system (ANS) functioning in adulthood. Psychotherapists not only tend to report higher rates of personal experience with early maltreatment, but also fewer mental problems and disturbances in adulthood, as compared to other professions. However, the role of the ANS in these processes has been understudied despite the relevance of the therapist's psychological state and related nonverbal communication for the therapeutic alliance. By comparing body psychotherapists to the general population, the present study aimed to explore the effects of practicing body psychotherapy (BPT) on the link between early maltreatment and autonomic reactivity in adulthood. An online study included 570 body psychotherapists from 35 countries (54% from the United States, M_age = 52.92, 81% of females) and 592 participants from the U.S. general population (M_age = 51.89, 78% females). We first inspected the factorial structure of the Body Perception Questionnaire-Short Form (Cabrera et al., 2018) in the specific population of BPT practitioners, confirming the three-factor model with one body awareness and two autonomic reactivity factors. Compared to the general population, BPT practitioners reported higher levels of childhood maltreatment, but fewer autonomic symptoms in adulthood, better differentiation of body awareness and autonomic reactivity, and a weaker association between childhood maltreatment experiences and present-day autonomic symptoms. Results are discussed in the framework of polyvagal theory (Porges, 1995, 2011). (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Supportive counseling skills like empathy and active listening are critical ingredients of all psychotherapies, but most research relies on client or therapist reports of the treatment process. This study utilized machine-learning models trained to evaluate counseling skills to evaluate supportive skill use in 3,917 session recordings. We analyzed overall skill use and variation in practice patterns using a series of mixed effects models. On average, therapists scored moderately high on observer-rated empathy (i.e., 3.8 out of 5), 3.3% of the therapists' utterances in a session were open questions, and 12.9% of their utterances were reflections. However, there were substantial differences in skill use across therapists as well as across clients within-therapist caseloads. These findings highlight the substantial variability in the process of counseling that clients may experience when they access psychotherapy. We discuss findings in the context of both the need for therapists to be responsive and flexible with their clients, but also potential costs related to the lack of a more uniform experience of care. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The COVID-19 pandemic forced governments to implement a range of public health measures that disrupted the personal and professional lives of many, including an abrupt adoption of telemental health services. Using data from a nonprofit counseling practice, we tested whether telemental health services delivered during the pandemic were inferior to face-to-face services delivered prior to the pandemic. We first characterized patients seeking therapy services before and during the pandemic to ascertain whether the demographics and presenting concerns of patients pre- and during COVID-19 differed and found that pandemic patients reported greater anxiety, greater overall distress, were more likely female and not partnered, and earned less than before the pandemic. We used a propensity score matching analysis to account for these differences and investigated whether or not telemental health therapy was inferior to face-to-face therapy. Based on the propensity-matched samples (2,180 patients in each condition), telemental health services were found not to be inferior to in-person services, allaying concerns about the effectiveness of telemental health services delivered during the COVID-19 pandemic. The present study also illustrates the usefulness of propensity matching for examining treatment effects in naturalistic settings. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

In recent years, mindfulness and compassion-based interventions (MCBI) have been found to beneficially influence the acquisition of essential skills in psychotherapy and are a promising way to improve relationships with patients. In this regard, new studies are needed to evaluate the effects of MCBI on psychotherapists and their patients and to analyze the influence of these effects on the processes and outcomes of psychotherapy. In this randomized controlled trial, we evaluate the efficacy of an MCBI in psychotherapists' mindfulness skills and self-reported empathy, as well as its indirect effect on patients (patient-reported psychotherapists' empathy, therapeutic bond, and symptomatology). Finally, we present a multilevel structural equation model (MSEM) to analyze the relationship between these variables in psychotherapists and their patients. A group of psychotherapists (N = 63) were randomized to an MCBI or an active control group (empathy diary). We assessed psychotherapists and their patients (N = 121) before and after the MCBI and at follow-up evaluation. Psychotherapists' results showed an increase in psychotherapeutic mindfulness skills (PMS) after the MCBI and at follow-up, whereas self-reported empathy improved at follow-up. Patients' results showed an improvement in perceived empathy, therapeutic bond, and symptomatology after the MCBI. The improvements in symptomatology were maintained for somatization and anxiety at follow-up. According to the MSEM, the increase in PMS is related to an increase in patient-reported psychotherapists' empathy, which produces an improvement in therapeutic bond and their symptomatology. These results support the benefits of introducing MCBI in psychotherapists' training to improve the psychotherapy outcomes. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The self-stigma (i.e., shame) associated with psychotherapy is a prominent barrier to seeking psychological help, but less is known about its effects after treatment begins. Evidence suggests that self-stigma may interfere with the formation of the therapeutic alliance, but no studies have examined this throughout the course of psychotherapy. Self-stigma's erosion of the alliance may be most pronounced when clients experience heightened psychological distress, but this also has not been examined. Therefore, the present study addresses these omissions among 37 clients who completed at least three therapy sessions for research credit. Participants completed measures of self-stigma and past-week symptoms of distress before each session and ratings of the working alliance after. Predictor variables were disaggregated into between-person (time-invariant or average levels) and within-person (time-variant or session-by-session changes) components to enable investigation of for whom (and under what conditions) self-stigma was associated with the therapeutic alliance. Results indicated that higher levels of self-stigma (between and within persons) predicted a worse alliance. When examined as an interaction effect alongside distress in a multilevel moderation model, higher between-person ratings of self-stigma predicted a weaker therapist-client alliance across levels (M ± 1 SD) of within-person distress. Notably, its effects became more pronounced as symptoms of distress increased, indicating a period in which clients are simultaneously most likely to need help yet least likely to feel allied with their therapist. Findings highlight the importance for therapists to simultaneously monitor and consider both average and session-by-session fluctuations in self-stigma and distress to develop and maintain the working alliance. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Goldfried (1982) hypothesized that there are five transtheoretical principles of change that guide routine psychotherapy practice. This survey investigated if there is consensus on the perceived presence of these principles in the approaches of a professionally diverse pool of psychotherapy clinicians and researchers. One thousand nine hundred ninety-eight participants, aged 21-85 years (M = 50.4 years, SD = 15.59) and representing a wide variety of theoretical orientations, completed an online survey. For consensus to be indicated, 95% confidence intervals of mean agreement scores had to be above 4.0 (out of 5). Mean agreement levels in response to "the extent to which you agree that the following principles are present in your own approach to psychotherapy" indicated consensus for all five principles: (a) fostering hope, positive expectations, and motivation (M = 4.58; 95% CI [4.53, 4.62]); (b) facilitating the therapeutic alliance (M = 4.76; 95% CI [4.73, 4.80]); (c) increasing awareness and insight (M = 4.66; 95% CI [4.63, 4.70]); (d) encouraging corrective experiences (M = 4.44; 95% CI [4.39, 4.48]); (e) emphasizing ongoing reality testing (M = 4.15; 95% CI [4.09, 4.20]). These findings were unaffected by age, gender, working patterns, practice (clinician or researcher), and years of experience; however, consensus on the final two principles was not indicated for both psychodynamic and experiential psychotherapists. The demonstrated consensus surrounding the transtheoretical principles of change corresponds with their consistently yielded outcome associations in previous research. The combination of these evidence sources points to the importance of the principles in routine psychotherapy practice, which warrants further investigation. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The discussion of the influence of culture in psychotherapy is expanding to honor and incorporate the ways identities intersect within complex social systems. Some clients present for therapy with two or more identities that are in conflict, whereby the values or needs associated with different parts of the self are at odds. The resulting tension can be a significant driver of distress. This study sought to investigate therapist variability in facilitating change with clients depending on the interaction of their sexual orientation and the role of religion in their life (RR). We analyzed the depression scores of clients (n = 1,792) who received care at a university counseling center. After controlling for clients' pretherapy depression scores, the association between their sexual orientation and their posttherapy depression varied across therapists; however, the association between their RR and posttherapy depression did not. We also found that the association between the interaction of clients' sexual orientation and RR, and posttherapy depression varied across therapists. Therefore, some therapists had clients who experienced more or less change in their depression and that variability was predicted by the identity combinations clients endorsed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Chronic pain is common among adults and frequently interferes with regular functioning while reducing quality of life. Though pharmacological approaches are used most frequently to treat pain-related issues, the side effects often lead to other problems. Group therapy has been used and studied for decades in treating pain although its general efficacy in this is not clear. We conducted a meta-analysis to determine group therapy's effectiveness in reducing pain intensity and improving adjacent issues. Potential randomized clinical trials were selected from various databases and included if published between 1990 and 2020, investigated group treatment's efficacy for pain-related concerns, measured pain intensity, included a comparison condition, and reported sufficient data in each trial arm at the first postassessment. We included 29 studies representing 4,571 participants in group therapy being treated for pain. The analysis yielded a significant, small effect when group was contrasted against passive control groups (g = 0.26, 95% CI [0.11, 0.41], p = .001) on the reduction of pain intensity. Two variables were found to moderate group therapy's efficacy: gender composition of groups and theoretical orientation. Although effects on reducing pain intensity are small, group psychotherapy should be considered a viable treatment option for chronic pain patients given the lower risks of side effects compared to pharmaceutical analgesics and comparable effects compared to other chronic conditions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Gaining insight is considered a cornerstone of psychodynamic psychotherapy. Existing tools used to measure insight mainly include patients' self-report questionnaires and external coding of therapy sessions. To expand on the available tools, the present study developed a comprehensive coding system for the Self-Understanding of Interpersonal Patterns Scales-Interview (SUIP-I; Gibbons & Crits-Christoph, 2017). A total of 55 patients enrolled in a randomized controlled trial received psychodynamic psychotherapy for depression and were interviewed using the SUIP-I at baseline. A comprehensive coding system was developed for rating the interviews, based on a Likert scale for each of the six levels of insight. The content validity, psychometric properties, and the reliability and validity of the coding system were examined. The new SUIP-I coding system demonstrated interrater reliability in the "excellent" range, ICC (1, 1) = .91-.97, for all the six levels, and adequate internal consistency (Cronbach's α = .81). Support for convergent validity was gained, as manifested in a significant positive association of the SUIP-I with alliance expectation and affiliation, and a significant negative association with avoidance attachment. Support for discriminant validity was also gained, as manifested in a weak, nonsignificant association between the SUIP-I and self-esteem. The proposed comprehensive coding system shows good initial reliability and validity. Research is needed to further establish the psychometric properties of the new SUIP-I coding system. (PsycInfo Database Record (c) 2023 APA, all rights reserved).