Psychotherapy最新文献

Dynamic Interpersonal Therapy (DIT) is a brief, time-limited psychodynamic individual therapy in which depressive and anxious symptoms are understood as responses to interpersonal difficulties. Problematic interpersonal representations of the self and others are conceptualized in DIT as the interpersonal affective focus (IPAF), a predominant and recurring interpersonal pattern that is connected to the symptoms and becomes the foundation of treatment. This article reports the development of a typology for classifying IPAFs, which characterizes the predominant style based on contemporary interpersonal approaches. If such a typology can be shown to have validity in a clinical setting, it could have multiple uses that would improve understanding of how DIT works and for whom it might be effective, for example, assisting the therapist in formulating the IPAF, allowing investigations of treatment outcome and process research, and informing training. An IPAF typology was developed by means of a hybrid method of qualitative analysis of transcriptions of audio recordings of DIT sessions using data from a randomized control and feasibility trial. Results revealed four themes, that is, patterns of relating, which could be described as hostile-dominant, hostile-submissive, friendly-dominant, or friendly-submissive. Limitations include the sample size and diversity, the impact of the inclusion and exclusion criteria of the pilot feasibility trial, and the clinical need to titrate the IPAF. Future research should focus on the reliability and validity of the typology and whether it can be employed in outcome and process research. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The dominant narrative in much of the world, but especially the West, is that public safety and security are provided by policing. Psychotherapy invests in this dominant narrative via its reliance on emergency services provided by the state, such as 911 and police, to pursue the safety of clients and the larger society. However, the long-documented history of oppressive systems of policing suggest that these dominant narratives operate to protect powerful groups while surveilling and policing marginalized people, but particularly Black and Brown communities. As such, critical and abolitionist movements have rejected the idea that policing provides safety and have sought out alternative methods for ensuring community wellness and safety. Although the field of psychology has broadly expressed interest in growing its critical lens and interrupting systems of power, very little has directly addressed how carceral logics influence psychotherapy practice, and how this influences the client's sense of safety in therapy. This manuscript argues for an abolitionist approach to informed consent and safety planning in psychotherapy to address the disparate ways that clients, and especially marginalized clients such as Black and Brown people, experience psychotherapy's traditional use of systems of policing and state authority. Clinical illustrations are provided and future directions are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The therapeutic alliance has been consistently found to be a robust predictor of therapeutic outcome across various modalities of psychotherapy. Alliance ruptures are thought to occur commonly within each therapeutic dyad and, if left unresolved, are associated with premature termination and worsened psychotherapy outcome. Research efforts have identified V-shaped shifts in the alliance, characterized by a high-low-high pattern of postsession alliance scores, as a meaningful method of operationalizing rupture-repair episodes, but these efforts rarely evaluate the within-session process of the identified sessions. As a result, it is often unclear whether these sessions identified by methods based on postsession alliance measures are reflective of clinically meaningful within-session rupture process. This article aims to further explore the V-episode operationalization of rupture-repair episodes by assessing for convergence between rupture process identified by between-session measures and the within-session observer-based Rupture Resolution Rating Scale (3RS) in a single patient-therapist dyad in a 30-session brief relational therapy. V-episodes were operationalized using various previously utilized methods to identify ruptures based on postsession measures of alliance. Results of this case study demonstrate that postsession patient-rated V-episodes in the therapeutic alliance can be indicative of within-session rupture process, demonstrating convergence between within- and between-session measures of alliance process. Implications of these results for methodological approaches for identifying alliance ruptures are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Psychology, and the United States more broadly, finds itself at yet another reckoning point with White supremacy and anti-Black racism. The American Psychological Association has even recently apologized for psychology's role in upholding systemic racism and White supremacy, and articulated expectations for psychology's role in dismantling systemic racism and White supremacy throughout psychology. Yet, the norms of White supremacy pervade our professional and individual consciousness, resulting in our radical movements toward a "culturally responsive psychotherapy" seeking to adapt to, and ultimately becoming quashed by, the very oppressive systems it seeks to upend. In this article, I argue first that to address anti-Black racism and racial trauma in psychotherapy, it is imperative to move beyond notions of "culture" and "identity" to a structural competency model of psychotherapy and psychotherapy training. Structural competency and examples of its integration are briefly discussed. I then offer and expand upon two additional recommendations: That we must learn about and incorporate the incredible work of Black, Indigenous, and people of color scholars who have offered robust guidance in how to engage in healing racial trauma in individual and family psychotherapy; and, that to ethically engage in and develop an antiracist psychotherapy equipped to heal racial trauma, we must individually and collectively engage in our own conscientization and radical racial healing. Throughout, I emphasize the importance of prioritizing the work of scholars of color, whose work I seek here to integrate and build upon, but do so as a low socioeconomic status-origin, White woman with disabilities scholar situated at complex axes of both privilege and oppression. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Boswell et al. (2022) professional practice guideline builds an excellent, evidence-driven argument in favor of the routine implementation of measurement-based care (MBC). Nonetheless, as learned from the attempted implementation of evidence-based psychotherapies, presenting empirical evidence does not affect therapist behavior. As such, we argue for an actionable and practical professional practice guideline. We review some of the most hindering barriers to the implementation of MBC, and we offer guidance introducing some of the efforts needed to overcome them. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Boswell et al. (2022) persuasively make the case for and propose professional practice guidelines (PPG) for measurement-based care (MBC). Although the evidence for MBC is robust, implementing MBC effectively in practice requires skills and processes not discussed in the PPG. We discuss five problems with the PPG for MBC: The "what's in a name?" problem, lack of actionable actions problem, the stopwatch problem, the stock market problem, and looking for the keys under the light problem. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Studies suggest that racism affects the type and quality of health care that patients who are Black receive, perhaps in part because poorer patient-provider communication and less provider encouragement of patient involvement have been consistently reported for patients of color. In particular, Black women are 3-4 times more likely to experience dangerous and even life-threatening complications, and more likely to report mistreatment and neglect from medical providers and staff, during childbirth. Experiences with gendered racism during childbirth, which in itself is a vulnerable, intense, and potentially traumatic experience when proper support is absent, may lead to posttraumatic stress reactions. Psychotherapy can help affected clients to process gendered racial and childbirth traumas through: (a) the establishment of a safe, trusting, and collaborative therapeutic relationship, in which careful attention is paid to repairing alliance ruptures caused by cultural misunderstandings or gendered racial microaggressions, and (b) framing experiences and "symptoms" as understandable reactions to gendered race-based traumatic stress during childbirth. In addition to direct therapeutic intervention, therapists should collaborate with doulas and/or medical providers on patient care, and, separately, advocate for systemic-level change, supporting clients' lived experiences outside of the therapy room. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

There is a large body of research on the importance of addressing culture in psychotherapy. However, less is known about providing critically conscious and racially affirmative therapy for Black, Indigenous, and People of Color (BIPOC) clients in the context of ongoing systemic racism and racism-related stress and trauma, especially in the sociopolitical context of the United States. This article introduces and illustrates the Keeping Radical Healing in Mind Therapeutic Approach using a sample therapy session. To contextualize the therapeutic approach, we outline the need for antiracist and liberatory approaches to psychotherapy and describe in detail the Psychology of Radical Healing theoretical framework. The clinical stance that underpins the Keeping Radical Healing in Mind Therapeutic Approach includes helping clients develop, internalize, and nurture (a) Critical Consciousness, (b) Cultural Authenticity and Self-Knowledge, (c) Radical Hope and Envisioning Possibilities, (d) Collectivism, and (e) Strength and Resistance. To better meet the needs of BIPOC clients, the stance requires clinicians to develop their critical consciousness of systemic racism and interlocking forms of oppression. The clinical case of "Brenda," a Black woman experiencing the effects of racism-related stress while raising a young Black boy, is presented. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Interest in the association between patient and therapist's motion synchrony and the working alliance has been growing in recent years. This interest is part of a larger effort in psychotherapy research to study how the working alliance, being central to the therapeutic process, develops over the course of therapy. However, while previous studies suggest that such an association between motion synchrony and the working alliance exists, there are mixed results regarding the direction of it. The present single-case study seeks to shed light on these mixed results with a multimodal perspective of nonverbal synchrony. That is, through an exploration of a single case, the present study explores physiological synchrony as an indicator of context in which motion synchrony is associated with the working alliance. For this aim, a single case was chosen from a randomized control trial investigating short-term psychodynamic treatment for major depressive disorder. Statistical analysis identified an interaction between physiological synchrony and motion synchrony in predicting working alliance levels. Findings show that in the context of an antiphase pattern of physiological synchrony (negative association between physiological measures of the two participants), there was a positive association between motion synchrony and the working alliance. This study emphasizes the potential of a multimodal approach, while suggesting a possible explanation for mixed results in current literature that focuses on the association between motion synchrony and the working alliance. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The therapeutic alliance is considered an important mechanism of change in youth psychotherapy. Accordingly, it has become one of the most investigated psychotherapy variables. Yet, the theoretical and empirical literature on the alliance with young people is complex and has received criticism. This article aims to (a) critically review the existing knowledge on the alliance in youth psychotherapy from its definition to the existing research and (b) discuss some of the implications of this knowledge for clinical practice ad future research. This review highlights that the alliance in youth psychotherapy, as commonly measured, has a significant, although small, impact on outcomes; and that the alliance-outcome association may be influenced by the young person and the therapist's characteristics, as well as therapy types. This points to the importance of finding tailored ways of fostering a strong alliance when working with young people and questions the assumption of the alliance as a generic aspect of all types of youth psychological treatments. Attention to repairing alliance ruptures also emerged as key, especially to preventing early dropout in adolescent therapy. It is argued that despite its limitations, alliance research in youth psychotherapy can have important clinical implications to improve youth psychotherapy. A resumption of a conversation between the clinical and research field on the alliance is needed to better understand the nature and role of this important variable when working with young people and to use this knowledge to inform and improve clinical practice and therapeutic training. (PsycInfo Database Record (c) 2023 APA, all rights reserved).