Three widely used brief self-report symptom intensity measures used to assess clients seeking psychological therapy are the Patient Health Questionnaire-9 (PHQ-9), which focuses on depression, the Generalised Anxiety Disorder-7 (GAD-7), which focuses on anxiety, and the Clinical Outcomes in Routine Evaluation-10 (CORE-10), which focuses on general distress.
This study aimed to examine the statistical relations among the PHQ-9, GAD-7 and CORE-10, their level of inter-agreement and ability to predict clinical caseness.
All three measures were administered contemporaneously to 1103 clients seeking psychological therapy at a community clinic in England. Data were anonymised and analysed following ethical guidelines. The data analysis plan was preregistered via the Open Science Framework.
Correlations among the three measures ranged from r = 0.71 to 0.78, p < 0.001. The percent of clients meeting caseness criteria was highest for the CORE-10 (87.3%), followed by the GAD-7 (74.8%) and the PHQ-9 (71.0%). Agreement between pairs of measures ranged from fair to moderate (κ = 0.45 to 0.59), with the 3-way agreement also moderate (κ = 0.58). Structural Equation Modelling indicated these scales measured a common latent construct of psychological distress. The GAD-7 showed a modest ceiling effect, whereas the CORE-10 and PHQ-9 did not.
The high level of overlap among the three measures suggests they may not distinguish sharply among types of distress. Pending future repeated-measures research on the instruments' sensitivity to change, these findings suggest a single measure may suffice as a baseline measure of distress.
The Empty-Chair Task for Unfinished Business has been studied in relation to various issues, such as interpersonal conflicts or trauma. Despite having been proposed as a way to address grief, it has not been sufficiently studied in relation to clients' emotional processes which facilitate therapeutic changes in grief.
In this regard, this qualitative study aimed to track clients' emotional processes related to therapeutic change in an intervention based on the Empty-Chair Task for complicated grief.
The study analysed a sample of 12 participants with complicated grief, of whom seven showed clinically significant improvement in grief symptoms. Additionally, observer-based measures were utilised to triangulate qualitative observations.
It was observed that, in cases with successful outcomes, clients were able to address and transform core emotional pain (e.g., chronic loneliness) by fully experiencing it and, subsequently, embracing adaptive experiences (e.g., connection with the deceased). In contrast, unsuccessful outcomes appeared to be associated with difficulties in engaging with core emotional pain and accessing adaptive emotional states, such as compassion.
This study underscores the transformative potential of the task for complicated grief, with implications for clinical practice and training.
Although several studies have examined climate change-related concerns affecting mental health, it remains unclear what specific cognitions are present in clinical samples. The present study examines (1) the thought content of patients with climate change-related concerns and (2) their cognitive styles, as reported by therapists.
This study is a secondary analysis of a nationwide survey of German therapists on climate change-related concerns in their patients. We qualitatively analysed reports from a subgroup of N = 214 therapists regarding patients' thought content and cognitive styles with structural content analysis.
Therapists' reports revealed diverse themes of thought content as outlined in the literature, with the most prevalent categories reported by approximately half of therapists being the deadly threat posed by climate change (54.2%) and helplessness in face of collective inaction and individual inability (52.8%) as well as the paralysis and disengagement from life goals (48.1%) and the immediacy, celerity, and irreversibility of climate change (46.7%). The most commonly identified cognitive styles in the therapists' reports were rumination (50.0%), catastrophising (44.9%), and self- and other-blame (32.2%).
The findings indicate that recurring climate change-related cognitions in therapy correspond with established cognitive patterns and overarching themes such as loss and danger, commonly linked to depression and generalised anxiety. Preliminary associations with disorders like panic and adjustment disorder require further empirical validation. Clinically, assessing these cognitions may guide intervention adaptation and inform targeted psychotherapist training using relevant cognitive content.
As demand for accessible youth mental health support grows, digital helplines delivered across multiple communication modes offer promising reach and flexibility.
This study explores the barriers and enablers to delivering a multi-channel mental health helpline for young people, incorporating both volunteer and service user perspectives.
Using the Behaviour Change Wheel (BCW) and Capability-Opportunity-Motivation-Behaviour (COM-B) model, qualitative interviews were conducted with eight volunteers and five service users of a UK-based helpline. Thematic analysis identified key influences on delivery, which were mapped to relevant Behaviour Change Techniques (BCTs) for potential service optimisation.
Eleven themes were identified across COM-B domains. Physical Opportunity barriers included inflexible protocols and access limitations, while Reflective and Automatic Motivation enabled delivery through positive emotions and digital familiarity. Each delivery mode brought particular strengths and limitations: phone fostered a deeper emotional connection but demanded high cognitive effort and posed confidentiality concerns; webchat was familiar and enabled fluid expression; email allowed time to reflect but was slower and more impersonal.
The findings underscore that empathy and human connection remain fundamental, even within digital spaces. For practitioners, training volunteers in mode-specific communication skills is essential to ensure these qualities are maintained. Rigid templates, which may hinder rapport, could be adapted to allow greater flexibility while safeguarding staff and service users. At a policy level, the study highlights the importance of multi-channel delivery to maximise accessibility and user choice in helpline provision.
This study aimed to explore how therapists understand and approach patients' transitions between everyday life and therapy sessions.
This was a qualitative study of therapists' experiences, making their implicit knowledge explicit and systematised.
Twelve semi-structured interviews were conducted with psychodynamic/psychoanalytic therapists and analysed with inductive thematic analysis.
The therapists lacked a conceptual framework for patients' transitions but could use conversations about transitions as a tool for deepening the therapeutic work. Clear therapeutic frames made the transitions more visible. Facilitating transitions into a therapy session was easier than out of a session. The therapists described a wide variation in their understanding of patients' behaviours at the threshold of sessions, which was a rich source of information about the patients' problems and the therapeutic progress.
Therapists have to pay attention and adapt to each patient's transitional needs and the phase of the therapeutic process. The transitions seem to be linked to emotions related to the therapeutic setting and thus need to be addressed. Our study showed that therapists had implicit knowledge in this area. This knowledge needs to be made explicit and available in the treatment of patients, for psychotherapy training, supervision and continuing education. Furthermore, there is a need for theoretical and conceptual developments within this area. This study highlights a phenomenon in therapy that has not been explored at length in research, and thus adds a new perspective when it comes to face-to-face sessions.
Relationships are important for people with Multiple Sclerosis (MS). Social support contributes to well-being, and psychological group interventions show positive findings on quality of life, coping, and self-efficacy. The current article aims to report sharing and relating processes in an online group integrative psychological intervention named MyMS-Ally that contributed to positive change in five women with MS who participated in the study.
This study followed the principles of Longitudinal Interpretative Phenomenological Analysis (LIPA). Five women living with MS participated in an 8-week online integrative psychological intervention group. Qualitative data were collected at three different time points: before the start of the intervention, post-intervention, and at the 3-month follow-up. The findings presented here are part of a mixed-method feasibility and acceptability study for the MyMS-Ally intervention.
The longitudinal group experiential theme ‘transitioning from concealing MS to embracing its relational effect’ was developed to capture the changes participants experienced in their relationships with people with and without MS following their engagement with the MyMS-Ally intervention. From the point of hiding their symptoms and needs, they became more open to communication in their relationships. The temporal changes of the five participants were grouped under the three time points.
The findings demonstrate the pathways participants went through towards sharing and relating with their MS and the group processes they found most impactful. Processes were deemed more important than the psychological techniques employed during the intervention. Implications for the development of group psychological interventions for people living with MS and their evaluations are also discussed.
Psychologists work under high emotional demands, elevated performance expectations, and intense relational labour. These pressures can be exacerbated by two early maladaptive schemas (EMS) - unrelenting standards and self-sacrifice - which respectively foster unreasonable internal standards and a tendency to prioritise others' needs over one's own.
This qualitative study explored how personal therapy relates to Australian psychologists' experiences of these schemas.
Semi-structured interviews were conducted with a sample of 20 Australian psychologists who had previously engaged in personal therapy, with data analysed using reflexive thematic analysis.
Three themes described a progression from awareness to reappraisal to practice change. First, making schemas visible captured how therapy helped participants name where patterns arise and notice their impacts on self-evaluation, boundaries, and energy. Second, reappraising the professional self involved loosening perfectionistic benchmarks, redistributing responsibility between clinician and client, and cultivating self-compassion. Third, translating insight into practice described schema-focused actions to counter pulls toward over-giving and relentless exceptionalism.
Findings suggest personal therapy may help psychologists recognise and respond to unrelenting standards and self-sacrifice, with implications for postgraduate training, supervision, and workforce sustainability.
School counselling work that is based on Western individualistic cultural values and focuses on the individual's self-fulfilment sometimes clashes with the collectivistic, authoritarian, patriarchal and traditional values of Arab society. Consequently, Arab women face unique ethical dilemmas and challenges in their work as school counsellors, especially in cases that require reporting to the legal authorities.
This paper presents qualitative research based on semi-structured interviews with 16 Arab female school counsellors.
Five main themes of dilemmas emerged from an analysis of the interviews: dilemmas at the personal level, pupil level, school staff and administration level, family and community level, and institutional level.
This research underlines the complex nature of the work of Arab school counsellors considering the gaps between Arab culture and the values of the counselling profession, and the gender-related disparities in power between female counsellors and male school principals. Therefore, a blind and culturally insensitive application of the core principles of counselling may be detrimental in some ways, just as acting blindly in accordance with the values of Arab society may be harmful in other ways, especially vis-à-vis individual rights.
Trust is a fundamental aspect of human relationships, crucial for navigating social interactions and forming meaningful connections. While the ability to accurately assess and update trust appraisals is essential for adaptive functioning, individuals with borderline personality disorder (BPD) experience significant challenges in trust processing that contribute to interpersonal dysfunction and treatment complications. Despite growing recognition of trust difficulties in BPD, a comprehensive understanding of these processes remains limited.
The present study aimed to evaluate and refine this model through a qualitative analysis of interviews with 25 Italian therapists specialising in personality disorders. Using thematic analysis, we explored clinicians' observations of trust dynamics in BPD patients, focusing on developmental factors, situational perceptions, emotional influences, prior beliefs, behaviours and trust learning capacity. Our findings largely aligned with and extended the theoretical model of trust impairments in BPD proposed by Preti et al. in 2023.
Results revealed a complex interplay between long-term and immediate factors in shaping trust processes: developmental experiences, rigid perceptions, emotional volatility, distorted beliefs, maladaptive behaviours, and impairment in trust learning were central to the trust dysfunctions in BPD. Two significant additions to the model emerged: emotional consequences of trust misattribution and behavioural activation triggered by emotional arousal.
These findings suggest that trust difficulties in BPD involve both planned behavioural consequences and immediate emotion-driven reactions. The study provides important implications for clinical practice, emphasising the need for interventions that address both primary trust issues and secondary emotional-behavioural responses.
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