Psychotherapy最新文献

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).

Deficits in emotional processing are considered to underlie a range of psychopathologies, and thus constitute a crucial target to improve mental health. Given the broad consensus on the importance of emotional processing during psychotherapy to reduce symptomology, it is surprising that there is no self-report scale designed to measure this construct. The purpose of this study was to develop the Emotional Processing Self-Report (EP-SR), a practical easy-to-use tool for assessing client emotional processing during therapeutic sessions. In Study 1, 53 items were developed according to theory and evaluated by experts. Exploratory factor analyses of the newly created EP-SR items were administered in a cross-sectional design to 124 individuals in treatment. In Study 2, multilevel exploratory factor analyses were performed on a sample of 114 patients who completed the EP-SR after each therapy session (1956 measurements). The results indicated that the EP-SR could be used to assess three independent lower order emotional processes: emotional expression, regulation, and understanding emotional meaning. In Study 3, multilevel confirmatory factor analysis was conducted on additional sample of 77 patients who completed the EP-SR after each therapy session (1,423 measurements). Results confirmed the factor structure of the EP-SR. The internal consistency, convergent, incremental, and predictive validity of the EP-SR were confirmed by showing its association with clients' process and outcome measures. The results of these three studies support the reliability and validity of the EP-SR and its clinical importance. Given its user-friendliness and strong psychometric properties, the EP-SR emerges as a good instrument to assess individuals' emotional processing. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

In this preregistered Prospero (CRD42022334071) review, the authors updated a meta-analysis review that examined the relation between therapist facilitation of patient emotional experience/expression and outcome in psychodynamic psychotherapy. Computer, manual, and backwards searches were conducted for relevant publications, and 14 independent samples of short-term dynamic psychotherapy were included in the meta-analysis. Data analysis included calculation of an overall effect size of the relationship between therapist affect focus and outcome, statistical significance, and test for homogeneity. In addition, moderator analyses were conducted to examine the potential impact of the methodological quality of individual studies. The overall weighted average r was .265, which was statistically significant, p < .001 (k = 14; 95% confidence interval [.130, .392]), indicating that therapist affect focus was associated with greater degree of patient change over the course of psychodynamic therapy. The results were not demonstrably heterogeneous, Q(13) = 14.787, p = .321, I² = 12.085, and publication bias analyses did not indicate cause for concerns regarding the results (all ps > .05). Trim-and-fill results indicated an adjusted weighted average r of .250 (decrease of 5.660%). None of the moderator analyses examining study methodology quality were statistically significant (all ps > .10). These data indicate that therapist facilitation of patient affective experience/expression is associated with patient improvement over the course of psychodynamic psychotherapy. The size of this relation was not significantly related to methodological quality. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Exposure and response prevention (ERP) is an effective treatment for obsessive-compulsive disorder. However, ERP's distressful nature may be too demanding for some patients, resulting in low engagement with treatment or even dropout. The current review aimed to summarize and categorize the components of ERP plus add-on protocols. Studies were deemed eligible when an ERP treatment was combined with a psychological add-on in the treatment of adult obsessive-compulsive disorder patients. Nineteen studies fulfilled the inclusion criteria. Add-ons were divided into eight categories: acceptance and commitment therapy, cognitive therapy-based interventions, family accommodation, inhibitory learning theory strategies, inhibitory training, mindfulness-based techniques, and motivational interviewing. Studies were divided into two methods of combining ERP with an add-on: the additive and the integrative format. These types of protocols may offer a feasible way for clinicians to personalize, according to the patient's needs, an otherwise structured treatment, increasing its responsiveness. Future studies, besides studying the efficacy of these adaptations, should also assess whether clinicians who are reluctant to use exposure therapy are more willing to employ the technique in an ERP plus add-on protocol. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

The objective of this study was to examine the experiences and expertise of Black mental health professionals (BMHPs) who work with Black racial trauma across the lifespan. Authors conducted a qualitative study with a critical-ideological paradigm as the methodology of this study. Twenty-five BMHPs (psychologists and counselors) were interviewed about their experiences working with Black clients suffering from racial trauma. Four superordinate themes were identified in the analysis of the data describing (a) how BMHPs define racial trauma and the effects they see racial trauma having on Black persons, (b) how BMHPs work to alleviate the symptoms of racial trauma, (c) the toll that working with racial trauma takes on their own well-being as BMHPs, and (d) ways BMHPs engage in restorative practices in order to continue to engage in the work of healing within the Black community. BMHPs report a strong sense of calling to work with Black persons suffering from racial trauma. They also report joy in their work, yet the complexity of working with racial trauma can be emotionally exhausting. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

A number of studies have shown an association between therapist skills (particularly insight skills) and the working alliance, but few studies have examined the directionality of this relationship. In addition, studies have used either the client or therapist report of the working alliance rather than a dyadic perspective. Thus, we examined whether (a) dyadic insight skills are indirectly related to client outcome through the working alliance and (b) the dyadic working alliance is indirectly related to client outcome through insight skills. The dyadic working alliance was measured as a latent, dyadic average of both the client and therapists' reports of the working alliance. Therapist use of insight skills was operationalized via the use of skills such as interpretations, immediacies, challenges, and disclosures of insight. We used dynamic structural equation modeling to analyze longitudinal data in long-term, psychodynamic treatment. Results indicated that at the within-client level, the use of insight skills was associated with the working alliance in the next session, and the working alliance was associated with therapist use of insight skills in the next session; however, there were no mediation effects. However, at the between-client level, the pathway from working alliance at T-1 to therapist use of insight skills at T-2 to client outcome at T-3 was significant but only for clients in longer term treatments. Findings reveal the importance of the working alliance as a signal for therapists to use insight skills for client improvement in long-term, psychodynamic therapy. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Subgroups in group therapy have long been considered an important concern. In this study, we examined how identity-based faultlines (i.e., the likelihood of splitting into subgroups based on member demographic information; Meyer & Glenz, 2013) would moderate the link between therapeutic factors and the reduction of psychological distress. Using data from 26 Chinese counseling groups comprising 141 group members (52.34% women, M_age = 22.41), we investigated the relations between identity-based faultlines (group level), early therapeutic factors (member level, measured at Session 2), and group members' psychological distress (member level). Results from the two-level linear regression model indicated that being in a group with higher identity-based faultlines did not directly predict members' symptom reduction. Furthermore, high faultline seemed to facilitate rather than impede group process, such that a member's perceived helpfulness of the group process (therapeutic factors) in early group more strongly predicted symptom reduction in high-faultline groups and that members with higher levels of pregroup psychological distress reported more symptom reduction in high-faultline groups. Our findings provided new evidence that identity-based faultlines could also have positive effects on group therapy. We discussed the implications of identity-based faultlines in the Chinese context. (PsycInfo Database Record (c) 2025 APA, all rights reserved).