JOURNAL OF CONTEMPORARY PSYCHOTHERAPY最新文献

Despite the many years of research dedicated to psychotherapy, therapy outcomes do not seem to be improving over the years. One of the approaches that are trying to address this issue is the personalization of therapy according to client characteristics. Most of the approaches to personalization in psychotherapy are atheoretical, i.e., attempting to be applicable across theoretical approaches. There are limited attempts to develop theoretically coherent personalization within existing therapeutic approaches. This paper attempts to outline a framework for a theoretically coherent approach to personalization in emotion-focused therapy (EFT) that would also account for the client’s everyday-life interactions. EFT is an experiential-humanistic approach and thus a framework for personalization in EFT is also relevant for personalization approaches in other exploratory therapies. This paper introduces a framework for personalized, context-sensitive, emotion-focused therapy EFT (P-EFT). The framework covers three domains: (1) appropriate indication and adjustment of EFT to client goals, preferences, characteristics; (2) optimizing the therapist’s therapeutic work and being with the client; and (3) supporting in-session processes by facilitating outside-session client engagement/practices in the client’s everyday life. An outline of how research findings as well as a data informed approach could inform all of these three domains is also provided.

There is a clear association between relational dissatisfaction in romantic relationships and elevated mental health issues such as depression and anxiety. The association can run in both directions and adds complexity to both relationship and individual difficulties. One of the most studied relationship therapy approaches, emotion-focused therapy (EFT) for couples, focuses on the interactional cycle between partners and also stresses the importance of soothing individual vulnerabilities in order to transform troublesome relational interactions. Thus far, there has not been an attempt to describe a systematic framework for using EFT to work with couples with co-morbid mental health issues. This paper aims to address this gap. It builds upon both recent work in transdiagnostic EFT for individuals, and the EFT for couples framework as optimal scaffolding for a transdiagnostic EFT approach that targets relational issues as well as depression- and anxiety-related presentations in couples. The paper outlines several ways how individual’s chronic emotional vulnerability has the potential to rise to clinical levels of distress and complicate a romantic relationship. The paper then outlines specific therapeutic strategies how to work with individual’s emotional vulnerability and symptom distress it may bring, in the context of the couple relationship. The individual’s emotional vulnerability work is tracked along with relational interactions, in an effort to provide healing and transformational interactions and emotional experiences. A case example from a current research project is outlined to illustrate the use of specific therapeutic strategies and the clinical application of the transdiagnostic EFT approach to couple therapy.

An effective psychotherapy process includes multiple elements, one of which is the client’s motivation. While psychotherapy theories propose models to increase the functionality and well-being of clients, little is said about how to motivate clients along this process. Although client motivation is relevant for all major therapeutic approaches, there are not many investigations focusing mainly on this motivation, and especially exploring it in connection with the stages of the therapeutic process. Therefore, there is a need to understand the factors that motivate the clients in each stage of the psychotherapy and psychological counseling process. Many psychotherapy theories include these factors in their models, though they do not explicitly state them. This paper unravels these factors by presenting and integrating tools and strategies from multiple psychotherapy perspectives to increase and maintain client motivation during the therapeutic process. Using these tools and strategies is important, given that many clients skip or quit their psychotherapy sessions, which end up hindering or completely blocking the possibility to achieve the positive outcomes intended with the therapeutic process. The contribution of the present paper is synthesizing these tools and strategies within a single, staged therapeutic process model, which can be followed by therapists to increase therapy adherence and effectiveness.

One of the main limitations of routine outcomes psychotherapy studies is the lack of random assignment to treatment conditions, which precludes causal inference. At the same time, therapist effects and empirically supported therapy relationships have proven to be important and even more influential than the type of treatment. In this theoretical study, we propose using therapist effects estimation, which refers to the systematic differences in the effectiveness of improving patient outcomes between therapists, to mitigate this limitation. The theoretical rationale for treating different therapists’ treatments as different treatment conditions is presented in depth while referring to practical methods of examining therapist effects estimation at the individual sample level. The current study demonstrates how variation in the results obtained by therapists in field studies holds the potential to approximate a causal relationship between therapy and outcomes. In light of this, we recommend performing significance testing for the therapist effect in every psychotherapy study where this is possible, as well as advocating investing resources in the personal development of the therapist and giving room for clinical experience in decision-making.

Chronic sexual abuse in childhood can be directly associated with the formation of personality disorders such as BPD, with the majority of this abuse occurring in the family context. The objective of this article is to reference the importance of clinical and psychotherapeutic intervention from a systemic approach, prioritizing the analysis of interpersonal relationships, behavioral patterns repeated during the patient’s history and the adaptation of family roles learned during childhood to adulthood, obtaining extremely positive results in terms of remission of symptoms and general recovery of the patient.

Scholarly publications play a vital role in the advancement of psychotherapy, as a creative treatment strategy and as an empirically supported approach. The best scholarly articles integrate scientific methodology and clinical practice. Unfortunately, many mental health professionals devote their work responsibilities to one domain or the other, choosing to become academic researchers or full-time clinicians. The Psyche Awards were developed to highlight the most valuable journal articles that were published during the previous year. A total of 168 journals were screened to identify 128 interesting and useful articles, which were then sorted into 13 award categories. The 53 nominated papers were reviewed by a panel of four judges to identify the most valuable article in each topical area.

This manuscript challenges the notion of “therapist drift”—the deviation from evidence-based practices due to the partial application or non-adherence to treatment protocols—proposing that such deviations often reflect good clinical judgment and a commitment to personalized patient care. Drawing on recent research, we argue against the conventional wisdom that adherence to empirically supported treatments based on narrow diagnostic criteria guarantees superior therapeutic outcomes. We highlight the “dodo bird verdict,” which suggests the equivalence of different psychotherapy approaches in effectiveness, and scrutinize the American Psychological Association’s endorsements of empirically supported treatment relationships, emphasizing the move towards personalized psychotherapy. We argue that due to validity concerns of prevalent diagnostic taxonomies and the heterogeneity of desired therapy outcomes across diverse methods and patient needs, randomized controlled trials comparing treatments for fixed diagnoses are inadequate for guiding clinical decisions. We propose adjusting therapy to the patient’s unique characteristics and desired outcomes—not strict protocol adherence—indicates responsiveness and clinical acumen, necessitating a shift toward more nuanced, patient-centered therapeutic models.

Cognitive behavioral therapy (CBT) demonstrates clear efficacy in addressing suicidal thoughts and behaviors. However, considerable barriers limit the accessibility of CBT interventions for those experiencing suicidal crises. As a solution to these limitations, a stepped care model is adapted which presents a stratified framework attuned to suicidal ideation severity that may expand access and optimize outcomes. Through four levels - basic, intermediate, advanced, critical - calibrated to match intensity of therapeutic support to patient risk profiles and clinical needs, the Stepped Care Model promotes efficient, responsive care. Basic levels focus on community education, crisis lines, screening to enable early intervention for mild cases; while critical levels feature emergency hospitalization and stabilization care plans for individuals facing severe, acute suicidality. Challenges include gaps in assessing suicide risk complicating level assignments, ethical complexities in involuntary interventions, workforce preparedness in terms of CBT and suicidology competencies, and promoting interdisciplinary coordination. Recommendations include specialized clinical training, localized adaptation within health systems, technological integration to bolster care continuity, and ongoing collection of patient outcomes data. Refining implementation guidance will support sites in transforming service delivery models to be more preemptive, patient-centered and evidence-based - contributing significantly to suicide prevention while maximizing scarce resources. Success requires balancing clinical responsiveness, practical feasibility and scientific rigor in this Stepped Care Model approach for one of healthcare’s most vulnerable populations. Therefore, the aim of this review article was to explore and review the considerations for successfully implementing a Stepped Care Model approach that is optimized for treating suicidal ideation and behaviors.

In ths paper I outline my development over fifty years as a therapist, researcher and theorist. I started with empathy as a core helping process seeing it as a moment-bymoment information processing aid as well as a provision of the curative effects of human understanding. Over the years I added a focus on emotion as central to change, and proposed a number of necessary distinctions that needed to be made when working with emotion and concluded that one of the best ways to change emotion was with another emotion. In addition to my focus on moment by moment process I saw that identification of in-session experiential states and case formulation went beyond just being in the moment and helped provide more focus to an essentially phenomenologically based experiential approach.

Borderline personality disorder (BPD) is characterized by a pathognomonic instability of interpersonal relationships. Therefore, a good working alliance in the treatment of BPD may go beyond qualitative aspects like agreement on goals and mutual trust, and in particular depend on a balancing of instability. Yet, little is known about working alliance dynamics in the treatment of BPD. Using daily ratings of the Therapy Process Questionnaire, we retrospectively investigated assessments of the stability of the therapeutic alliance during inpatient treatment in 51 patients with BPD and 66 patients with major depressive disorder. Regression analyses were used to investigate whether working alliance was more unstable in patients with BPD and how it was associated to outcome. The working alliance was found to be significantly more unstable in patients with BPD. Yet, a high dynamic complexity of the working alliance was found to be linked to better outcomes in BPD, possibly hinting at the importance of rupture and repair.