Psychotherapy Research最新文献

Objective: To assess the frequency of alliance ruptures and repairs and their impact on treatment outcome in psychotherapy among patients with substance use disorder. The moderating effects of treatment orientation, attachment style and type of substance use were analyzed.

Methods: Eighty-three patients and six therapists reported alliance ratings after every session. The patients rated psychological distress before each session. Outcome was analyzed as change in psychological distress during the three sessions following a rupture and a repair. Ruptures were identified as an alliance drop in one session compared to the average scores of the three preceding sessions and repairs if alliance scores reached the levels before the rupture within the following three sessions.

Results: Fifty-two percent of the patients rated rupture(s) in the alliance, the therapists in 73% of the dyads. Patient-reported alliance ruptures, but not therapist-reported ruptures, contributed negatively to patients' psychological distress the following three sessions. Both patient- and therapist-reported repairs implied decreased psychological distress the following three sessions. A secure and a fearful attachment style moderated the relation between patient-reported alliance ruptures and deteriorated psychological distress.

Conclusion: Alliance ruptures seem to increase patient distress, while reparation is followed by decreased distress. Future studies may explore other moderators.

Objective: Postpartum depression (PPD) is common but undertreated, stressing the need for scalable psychotherapies. The reward system is a promising mechanism as PPD disrupts reward-supported behaviors: reduced motivation to engage in rewarding experiences (behavioral activation) and blunted pleasure during social interactions (social reward responsivity). Engage & Connect (E&C) is a simple and scalable psychotherapy, based on neuroscience literature. It aims to increase engagement in rewarding social experiences to restore reward-supported behaviors and reduce PPD.

Methods: In a one-arm pilot study, 38 women with PPD received 9-weeks of E&C. We tested whether E&C is feasible and acceptable. Using mixed-effects models, we tested whether E&C reduces PPD, mediated by improved reward-supported behaviors.

Results: We found that E&C was feasible and acceptable (86% retention). PPD severity significantly reduced during E&C (EPDS change = 8.6 points (SD = 3.8); 83% remission, 73% clinical response). Further, significant improvement in reward-supported behaviors (behavioral activation, social reward responsivity) mediated PPD reduction. Finally, anxiety severity, perceived social support, and infant bonding improved during E&C.

Conclusions: Results provide preliminary evidence that E&C may be a promising scalable first-line psychotherapy for PPD, pending testing in a randomized controlled trial. E&C might reduce PPD by improving reward functions with long-term benefits for mothers and infants. Clinical Significance: This pilot study suggested that Engage & Connect (E&C) is feasible and acceptable, with reduction in PPD and improvements in behavioral activation, social reward responsivity, social support, and infant bonding. Further, improvements in behavioral activation and social reward responsivity mediated PPD reduction. Pending replication in a larger sample, E&C may be a promising scalable first-line psychotherapy that reduces PPD by enhancing behavioral activation and response to social rewards.

Objective: A substantial number of therapists in the eating disorder (ED) field have experienced an ED themselves, yet research on professionals using their personal ED experience as a therapeutic tool is scarce. This study explores the perspectives of recovered ED professionals (REDPs) who intentionally employ their experiential knowledge in ED treatment, examining its use, advantages, and challenges.

Method: Semi-structured interviews were conducted with 20 REDPs using a topic list with open-ended questions based on our research aim and a previous literature review (Bijkerk et al., 2024).

Results: REDPs play a key role in treatment, with self-disclosure occurring in various forms. Experiential knowledge of REDPs offers benefits like motivation, hope, and understanding, but also challenges such as potential client burden or misguidance. Successful implementation of experiential knowledge requires organizational adjustments (supervision, work guidance and adequate training) and the REDPs' responsibility to create the right conditions for using their experiential knowledge efficiently.

Conclusion: Applying lived experience in practice by REDPs requires additional competence as it places these professionals into a difficult position of having to balance self-disclosure with ethical risks to clients and the risks to one's personal and professional self. Moreover, beneficial use of experiential knowledge in practice requires organizational support.

Objective: Uncertainty is an unavoidable aspect of healthcare service provision, particularly for psychologists who often navigate complex ambiguous clinical scenarios, which can evoke negative responses and increase risk of adverse outcomes. This study explores the willingness of Australian psychologists to communicate uncertainty to clients, identifying facilitators and barriers to this process.

Method: We surveyed 70 Australian psychologists providing direct client care. The survey focused on barriers and facilitators to communicating uncertainty through responses to a vignette depicting a common therapeutic scenario featuring uncertainty. Thematic analysis was undertaken using Nvivo.

Results: Key themes describing barriers included psychologist's internalization of uncertainty as personal and professional inadequacy, fear of negative client reactions, and a lack of skills in effectively communicating uncertainty. Conversely, facilitators included comfort with uncertainty, external professional supports, and strong therapeutic relationships.

Conclusions: The findings underscore the need for enhanced training of psychologists in uncertainty communication, focusing on developing adaptive responses and effective communication strategies. Addressing uncertainty is crucial given its inevitability, psychologist's pervasiveness discomfort with uncertainty and barriers to its communication. Future research should explore the nuanced experiences of psychologists in diverse practice settings working within a range of therapeutic modalities, and the impact of uncertainty on the therapeutic relationship.

Objective: This systematic review (PROSPERO CRD42023399665) synthesized evidence from process-based microanalytic studies investigating therapist-client verbal exchanges in psychotherapy, focusing on sequential and time-series patterns.

Method: From an initial pool of 1890 articles, 33 studies were included. Studies were conducted in 10 countries, retrieved from seven databases in three languages, and focused exclusively on outpatient psychotherapy. All studies employed observational coding systems and microanalytic methods to examine moment-to-moment interactions.

Results: Despite variation in coding systems and contexts, a consistent pattern emerged: when clients engaged in improvement-related verbalizations or followed therapeutic directions, therapists typically responded with approval, forming a triadic sequence (therapist prompt → client change-oriented verbalization → therapist approval). In contrast, therapists' responses to client verbalizations misaligned with therapeutic goals were inconsistent, showing no reproducible pattern across studies.

Conclusion: Although outcomes were not directly assessed, findings suggest that therapist-client verbal interaction systematicity relates to in-session change. To enhance microanalytic research, we argue for a bottom-up approach emphasizing detailed, AI-assisted descriptions of therapist-client interactions before applying theory-driven sequential analyses.

Objective: Reflective practice is vital to high-quality therapeutic work, enabling clinicians to critically examine their professional practices. Increasing opportunities to engage in reflective processes stands to increase clinician wellbeing and thereby improve quality of care. Generative Artificial Intelligence (GAI), specifically large language models, provide new ways for clinicians to gain insight into their work. This study explores a unique unintended consequence of GAI clinical notetaking platforms, the support of reflective practice among mental health clinicians.Method: Semi structured interviews were conducted with clinicians (n = 17) to learn about their experience using GAI clinical note-taking platforms. Interviews were recorded and analyzed using a grounded theory approach to identify themes.Results: Respondents described how AI platforms functioned as a reflective partner by offering alternative clinical interpretations, lending clarity to their existing practice approach, and creating space to be more present during sessions.Conclusions: AI note-taking platforms are a feasible and scalable way to support reflective practice. Implications for clinical training and ongoing professional development are discussed, and opportunities for future research on the use of AI tools to enhance reflective practice are identified.

The focus on therapist variables and characteristics has significantly increased in psychotherapy research in recent years. While ethical considerations for patient-participants are well-established, the unique ethical dimensions of therapist-subjects remain underexplored. This theoretical paper examines three critical ethical aspects specific to therapist-participants: power dynamics in hierarchical relationships, personal-professional boundary issues, and confidentiality challenges. We analyze how these considerations manifest particularly in training contexts where researchers often hold supervisory roles over therapist-subjects (e.g., faculty supervising student-therapists). The paper explores the complex interplay between informed consent and institutional hierarchies, especially when participation may be perceived as professionally expected rather than voluntary. We examine the implications of recording and analyzing therapy sessions that expose therapists' personal characteristics and professional competencies, particularly when coded by colleagues within small professional communities. While existing ethical frameworks address research participants generally, they lack specific guidance for the unique vulnerabilities of therapists who are simultaneously research subjects and professional practitioners. We propose targeted considerations for ethical research design, including enhanced informed consent procedures, structural safeguards for managing power differentials, and privacy protections tailored to professional contexts. This theoretical exploration aims to highlight overlooked ethical complexities and guide future research practices when therapists serve as subjects in psychotherapy research.

Objective: There is limited research examining factors associated with Dialectical Behavior Therapy (DBT) treatment retention among veterans, who are of critical interest given higher rates of suicide and borderline personality disorder (BPD). This study examined factors related to DBT treatment retention and BPD symptom trajectories among veterans.

Methods: Participants were veterans enrolled in a comprehensive DBT program. 145 veterans presented to the program, and 115 veterans were deemed eligible and enrolled. The relationships between mental health care utilization, suicide-related factors, military-related trauma, and demographic variables with treatment retention and BPD symptom trajectories were examined.

Results: Older adults were more likely to complete at least a portion of treatment, and veterans with higher education were more likely to complete treatment. Regarding treatment outcomes, a past year suicide attempt was associated with heightened baseline BPD symptoms and sharper reductions in BPD symptoms. Having a recent emergency room visit was associated with sharper reductions in BPD symptoms.

Conclusions: These results begin the work of identifying factors associated with treatment retention and outcomes in this high-risk population-with the aim of informing research focused on understanding who is the most likely to benefit from DBT, as well as identifying potential factors to inform DBT program processes.

Objective: Clinical supervision is considered an important aspect of therapist training. However, little is known about which elements of supervision impact on therapist skills. The current study used a qualitative approach to identify patterns of (in)effective supervision sessions for novice CBT supervisees.

Method: Sixteen supervision sessions were selected, based on deviant case sampling from a larger randomized controlled trial investigating the effect of clinical supervision for psychology students. Nine effective and seven ineffective supervision sessions were chosen, based on changes in independently assessed competence and alliance scores from pre- to post-supervision. Transcripts of these sessions were analyzed using thematic analysis.

Results: The analysis yielded four themes, each structured into two sub-themes: Shaping Supervision through Supervisee Agency, The Supervisor as a Tailor, Co-Constructing Supervision, and Creating a Space to Learn. Effective supervision sessions were characterized by supervisees working actively on their individual goals, the use of a variety of supervisory techniques tailored to the supervisees' needs, a collaborative exchange at eye level, and a supportive and empowering atmosphere.

Conclusion: Our analysis identified theoretically and clinically relevant processes in supervision that may foster novice CBT supervisees' skills. It emphasizes the potential of personalized approaches, building on a supportive atmosphere.