Psychotherapy最新文献

Given that spiritual and religious (S/R) topics can elicit discomfort and countertransference among psychotherapists, training frameworks that promote introspection and opportunities for repeated practice, or exposure, may be ideal starting points to develop S/R competencies. The current deliberate practice informed training program targeted cultural comfort and associated multicultural orientation constructs, aligning with prescribed attitude/awareness and broaching S/R competencies. This quasi-experimental, mixed method investigation analyzed whether a new S/R training program informed by deliberate practice principles was associated with changes in participants' (graduate students in graduate clinical/counseling psychology programs in the United States; N = 126) cultural comfort, self-perceived clinical performance, and self-perceived difficulty when engaging S/R video vignettes using specification curve analyses and a content analysis of follow-up interviews. Analyses indicated that all specifications had positive effects for the treatment (training condition, n = 65) for comfort (B_median = .46, range: .36-.58; 24 of 36 specifications were significant) and self-perceived performance (B_median = .48, range: .45-.55; all specifications significant). Analyses indicated that all specifications for treatment had an inverse association with self-rated difficulty, but all specifications were nonsignificant, suggesting no difference between training and control (n = 61) participants. Training condition participants indicated in a survey that the training was high quality, useful, and had no technology issues; the follow-up interviews with a smaller number of training condition participants provided insights into the training's strengths and weaknesses. The data in full create a roadmap for further study and training program modifications. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Family Competency addressing religion and spirituality in relationships is based on principles of systems theory applied to diversity training in religion and spirituality. Relational spirituality and family systems theory are the theoretical bases for training clinicians to address religion and spirituality (R/S) competently. Relational issues of R/S include religious differences and conflicts in close relationships, spiritual impairment due to relationship distress, and the use of spiritual resources for coping in a family or community. Principles of cultural humility and comfort, clinical assessment of R/S, nonanxious presence, multidirected partiality, and differentiation were used to train clinicians. Participants (N = 174) were graduate students and professionals in mental health care who engaged in a 5-hr online training with switching replication measurement at three points before and after the training at 2-week intervals. Measurement included a newly validated six-item global measure of couple and family spiritual and religious competency (J. S. Ripley et al., 2024) and the Religious/Spiritually Integrated Practice Assessment Scale (Oxhandler, 2019). Mixed-effects models with two-way cross-level interactions of Treatment Condition (Immediate Treatment, Delayed Treatment) × Time (T1, T2, T3) supported change based on the intervention, especially for measures of self-efficacy, attitude, increased frequency of R/S integrated practice, and global relational R/S competency. Qualitative analysis of interviews with some participants (n = 10) identified several experiential themes. The models showed significant change after the training and maintenance of gains for the immediate treatment group. In conclusion, this demonstrated the efficacy of the relationally based training model in improving R/S competency in training graduate students and professionals. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

This study evaluated the effectiveness of a live videoconferencing training program in spiritually integrated psychotherapy offered by ACPE: The Standard for Spiritual Care and Education (ACPE). We used a quasi-experimental one-group pretest-posttest group design to investigate whether participants' religious/spiritual competencies (self-efficacy, attitudes, and skills) improved and whether their use of spiritual interventions increased after completing the training program. We also assessed whether their perceptions of the barriers to practicing spiritually integrated treatment in their practice setting changed after training. The research participants were 84 adult men and women from diverse spiritual backgrounds, mental health specialties, and geographic locations who completed the measures before and after the training program. A repeated measures multivariate analysis of variance and follow-up t-tests revealed that the participants' spiritual competency and usage of spiritual interventions during treatment sessions significantly increased after the training program. Most Cohen's d effect sizes were large or moderately large, indicating that the improvements were educationally and clinically meaningful. The study provides preliminary evidence that ACPE's live, videoconferencing spiritually integrated psychotherapy training program enhanced the spiritual competencies of the participating mental health and pastoral professionals. (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) 2025 APA, all rights reserved).

Strengths use, the engagement of positive character traits in everyday contexts, is associated with both positive functioning and symptom reduction. The present study examined longitudinal relationships between strengths use and emotional disorder symptoms (anxiety, stress, and depression) during a randomized clinical trial of the Digital Unified Protocol, a transdiagnostic cognitive behavioral therapy. Participants (N = 120) completed assessments at four major time points during treatment and at 3-month follow-up. We specified three random-intercept cross-lagged panel model to capture within-person, bidirectional, time-lagged relationships between strengths use and anxiety, stress, and depression, respectively. Prospective increases in strengths use were associated with significant decreases in anxiety at all time points (β = -0.26 to -0.49), while prospective decreases in anxiety were associated with significant increases in strengths use at most time points (β = -0.25 to -0.36). Prospective increases in strengths use were associated with significant decreases in stress at most time points (β = -0.23 to -0.54), while prospective decreases in stress were associated with significant increases in strengths use at Week 4 (β = -0.21) and at follow-up (β = -0.41). Prospective increases in strengths use were associated with significant decreases in depression at Week 8 (β = -0.63) and at posttreatment (β = -0.67), while prospective decreases in depression were associated with significant increases in strengths use at most time points (β = -0.34 to -0.47). Clinical implications of findings are discussed, including the potential role of strengths use as a treatment target. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Deliberate practice has been introduced to psychotherapy training to improve therapist performance. The emerging empirical evidence supporting the positive impacts of deliberate practice is complicated by confusion regarding how deliberate practice should be operationalized and applied in the psychotherapy context and wider debate about its role in developing expertise. This systematic literature review aimed to appraise and synthesize the preliminary evidence available regarding the role of deliberate practice in improving psychotherapy outcomes. We searched MEDLINE, EMBASE, APA PsycInfo, CINAHL, Web of Science, reference lists of articles, and other sources (last checked June 2023). Quantitative English language studies that examined deliberate practice interventions in psychotherapy contexts were included. Two authors independently extracted study data and assessed quality using the relevant Joanna Briggs Institute critical appraisal checklist. Randomized controlled trials were further appraised using the Cochrane risk of bias tool. Discrepancies were resolved through discussion with a third author (Stephen Arthey). Twenty studies were included. There was wide variability in how deliberate practice had been operationalized, and only three studies met the contemporary definition that experts in the field have clarified. Significant methodological limitations impacted the reliability of studies, and the evidence was too preliminary to support or refute its use. Further research is required to establish whether deliberate practice is an effective means of improving psychotherapy outcomes. This should include increased fidelity to contemporary operationalizations, more robust methodology, and more reliable measures of long-term client outcomes. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Complementing the oft-studied construct of interpersonal isolation, research has increasingly focused on existential isolation (EI), or the subjective feeling of separateness in one's experience. In the clinical realm, several studies have demonstrated that higher EI is associated with more severe mental health problems at a single cross-section of time. Moreover, one study showed that higher pretreatment EI predicted worse psychotherapy outcomes. However, it remains unknown whether an average level of EI across all of psychotherapy (a type of during-treatment "trait") and/or fluctuations in EI during psychotherapy (a type of during-treatment "state") relate to broader treatment outcomes. Addressing EI in this more nuanced and complex manner, the present study parsed the EI-outcome association in its between- (trait) and within-patient (state) components in the context of naturalistic outpatient psychotherapy (Constantino et al., 2021). Participants were 46 therapists treating 144 patients who provided enough EI and outcome data to establish average, longitudinal, and temporal associations across treatment. Using a random intercept cross-lagged panel model, the between-patient results showed that higher average EI was associated with worse average outcomes (standardized association = .60, p < .001). However, although within-patient EI demonstrated significant variability over time, such fluctuations were unexpectedly unrelated to subsequent changes in outcome-when accounting for prior EI and outcome changes (p = .617). The findings suggest that although EI seems to possess both traitlike and statelike qualities, the former component may have the greatest influence on treatment outcomes, whereas the latter may be more of an outcome in itself. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Interpersonal problems have been identified as a potential risk factor for a weaker therapeutic alliance during psychotherapy, yet their temporal relationship and underlying dynamics remain unclear. To address this, the present study explores these associations during the first 20 sessions of cognitive behavioral therapy. The data from 2,123 patients undergoing treatment in an outpatient clinic were analyzed. Interpersonal problems were assessed every fifth session with the 12-item version of the Inventory of Interpersonal Problems-12, while therapeutic alliance was measured after every session with the Session Rating Scale. Temporal associations were modeled using both a random-intercept cross-lagged panel model and an autoregressive latent trajectory model with structured residuals, as they allow the differentiation of within- and between-patient components. The random-intercept cross-lagged panel model produced more reliable and interpretable estimates. At the within-patient level, contemporaneous associations were significant, indicating that higher-than-usual interpersonal problems within a session were associated with lower-than-usual experienced therapeutic alliance at the same time point (β = -.067 to -.074, p = .005). Over time, higher-than-usual interpersonal problems negatively influenced therapeutic alliance at the next assessment (β = -.052 to -.063, p = .032), while higher-than-usual therapeutic alliance predicted reductions in interpersonal problems five sessions later (β = -.051 to -.083, p = .002). These findings suggest a reciprocal dynamic between interpersonal problems and therapeutic alliance, where improvements in one construct are associated with beneficial changes in the other over time, highlighting the importance of addressing interpersonal difficulties to strengthen the therapeutic alliance. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Over the past 2 decades, a growing body of research has revealed that therapists differ in how effective they are at facilitating change depending on their clients' social identities (see Imel et al., 2011, for example). Most studies examining the phenomenon of variability within therapists' caseloads are based on the study of client race/ethnicity. However, two were recently published that found that therapists varied in the association between their clients' sexual orientation and their therapy outcomes (Cabrera et al., 2023; Drinane et al., 2022). The present study sought to replicate and expand upon these findings in a national data set composed of 78,681 clients from university counseling centers who are part of the Center for Collegiate Mental Health. We employed multilevel modeling techniques to detect within-therapist disparities based on client sexual orientation on the following three outcomes: depression scores, an index of distress, and treatment dropout. The association between sexual orientation and all three outcome variables varied significantly across therapists. The presence of sexual orientation disparities within therapist caseloads in such a large and widespread sample is concerning and highlights a need for the analysis of other demographic variables and training that might mitigate this problem. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

To test the hypotheses that supervision improves therapeutic skills and therapeutic alliance (Hypothesis 1) and that this effect is stronger for immediate rather than for delayed supervisory feedback (Hypothesis 2). Eighty psychology students (M = 24.29 years; 72.5% identified as female; 75.0% were studying for a bachelor's degree) conducted three consecutive sessions with a standardized patient in a simulated therapy. These students were randomly assigned to live supervision (LS) or delayed video-based supervision (DS). While the LS group received support from a supervisor during the second session, the DS group received such support after the second session. Several outcomes (students' skills, self-efficacy, fear of negative evaluation, therapeutic and supervisory alliances, and supervision quality) were assessed from different perspectives (i.e., independent raters, students, patients). From all perspectives, supervision significantly increased students' skills and self-efficacy, and the therapeutic alliance (d = 0.29-0.49, Hypothesis 1). Moreover, LS was not significantly superior to DS in any of the outcomes (Hypothesis 2). In addition, students subjectively perceived DS as more effective (d = 0.83, 95% confidence interval [0.37, 1.29]), but they identified the supervisory relationship as equally pleasant and the feedback as equally helpful in both conditions. Supervision positively influenced students' skills and self-efficacy, and the therapeutic alliance, and both LS and DS were viewed as high quality. Thus, live and delayed supervision formats have comparable effects. However, future research should further investigate the specific mechanisms through which they exert their positive influences. (PsycInfo Database Record (c) 2025 APA, all rights reserved).