Psychotherapy Research最新文献

Feedback-informed treatment (FIT) has been shown to reduce the gap between more and less effective therapists. This study aimed to examine therapists' professional characteristics as potential moderators of the effect of feedback on treatment outcomes.

The IAPT-FIT Trial was a clinical trial where therapists were randomly assigned to a FIT group or a usual care control group. Treatment response was monitored using measures of depression (PHQ-9), anxiety (GAD-7) and functional impairment (WSAS). In a secondary analysis of this trial (n = 1,835 patients; t = 67 therapists), we used multilevel modelling to examine interactions between therapists' professional characteristics (e.g., attitude towards and self-efficacy regarding feedback utilization, decision-making style, job satisfaction, burnout, difficulties in practice, coping styles, caseload size) with random allocation (FIT vs. controls) to identify moderators of the effects of feedback.

Between 9.6% and 10.8% of variability in treatment outcomes was attributable to therapist effects. Therapist-level caseload sizes and external feedback propensity (EFP) moderated the effect of feedback on depression outcomes. No statistically significant main effects were found for any of the included therapist characteristics.

FIT reduced variability in outcomes between therapists and was particularly effective for therapists with high EFP and larger caseloads.

Objective: Deliberate practice (DP) is recommended as a new approach to facilitate the acquisition of discrete therapeutic skills, however, its implementation and effectiveness in psychotherapy remains unclear.

Method: A systematic search on DP for therapeutic skills among psychotherapy trainees and psychotherapists yielded eleven studies for inclusion. Nine were randomized controlled studies (RCTs), including seven unique RCTs, and two were within-group studies.

Results: Risk of bias was assessed as "high" for one RCT, "some concerns" for the remaining RCTs, and "serious" for within-group studies. All RCTs found the DP group performed better than the control group. All studies involved efforts to improve performance based on learning objectives and iterative practice but varied in the source of expert guidance and feedback. The included studies provide limited insight into best practice for delivering DP.

Conclusion: The results highlight the paucity of research in this field; however they offer insight into current applications of DP and provide preliminary empirical support DP for as a model for promoting the development of discrete therapeutic skills. Given the rapid dissemination of DP publications and manuals in psychotherapy, future research is strongly encouraged.

Objective: This study scrutinizes the meaning of deterioration in psychotherapy beyond the widely used statistical definition of reliable symptom increase pre-to-post treatment.

Method: An explanatory sequential mixed-methods multiple case study was conducted, combining quantitative pre-post outcome evaluation of self-reported depression symptoms and qualitative analysis of patients' interviews. In a Randomized Controlled Study on the treatment of Major Depression, three patients showing reliable increase in symptom severity on the BDI-II pre-to-post therapy were selected. An interpretative phenomenological analysis (IPA) was performed on individual interviews conducted pre-, peri- and post-treatment.

Results: Cross-case outcome experiences were: (1) uncontrollable complaints; (2) remaining questions and uninternalized insights and (3) persisting interpersonal difficulties. Within-case idiosyncratic differences revealed that the statistical classification of "deterioration" not necessarily corresponds to a "deteriorated experience," nor univocally indicates unwanted therapy effects. Our findings point at the influences of the patient's (lack of) agency in the process, a discrepancy between patients' expectations and the therapy offer, the therapeutic relationship, interpersonal difficulties, and contextual influences.

Conclusion: The meaning of symptomatic deterioration should be interpreted within a patient's idiosyncratic context. The multi-faceted nature of deterioration requires further research to rely on multiple perspectives and mixed methods.

Background: This study aims to evaluate the factor structure, reliability, and validity of the Clinician Affective REsponse (CARE) scales, a 15-item self-report measure designed for practical use in psychotherapy settings. Methods: Validation data were gathered from 151 mental health clinicians. These clinicians completed the CARE scales alongside measures capturing sociodemographic and professional details, patient demographics and clinical details, therapeutic intervention characteristics, therapeutic relationship elements, and session outcomes. Results: The CARE scales had a three-factor structure: positive engagement (k = 5, ω = .78), enmeshed (k = 5, ω = .72), and stuck (k = 5, ω = .71). Confirmatory factor analysis (CFA) yielded the following fit indices for the three-factor model: χ²₍₈₇₎= 120.41, CFI = .94; TLI = .93, RMSEA = .05, and SRMR = .08. Multigroup CFA (which pooled two samples for a total of 607 subjects) showed that the CARE scales were invariant across remote and in-person session formats. The scales showed meaningful correlations with concurrent measures of working alliance, real relationship, countertransference, patient's experience of the therapeutic relationship, and session outcome. Discussion: The CARE scales are a valuable instrument in clinical, training, and research contexts, adept at capturing clinicians' session-level affective responses and perceptions of the therapeutic relationship. Quantifying these reactions facilitates statistical analysis and empirical research, while their monitoring can guide therapeutic interventions and inform clinical supervision.

Objectives: This qualitative study explored changes described by individuals with complex dissociative disorders (CDDs) 2 years after participating in a psychoeducative group. Few recent studies have examined the early changes from incomprehensible reactions to the integration of traumatic events.

Methods: Interviews were conducted with 25 participants with CDD 2 years after completing a 20-week psychoeducative skills training group. Transcripts were analysed using an interpretive phenomenological framework.

Results: Three pathways of change were identified: (1) the ability to be present in life, (2) ways of approaching internal conflicts and (3) the degree of ownership of the self. These pathways illustrate the initial steps towards integration, in which participants start recognizing and confronting previously avoided emotions and experiences. This allows them to better tolerate and accept more of themselves. Processes varied among the participants, with some achieving cohesive integration of challenging memories.

Conclusion: Traditionally, there has been little treatment optimism for individuals with CDD. This study highlights the potential for comprehensive change within 2 years. It contributes to the debate on whether focusing on coping strategies delays trauma memory integration, emphasizing the need for a balance between exposure and coping based on the patient's capacity.

Objective: This study examines if experiencing the sequence of primary maladaptive emotions followed by primary adaptive emotions in-session predicts therapeutic change and whether this sequence mediates the impact of therapist emotional reflections on outcomes at post-treatment and follow-up.

Method: Nineteen participants with high self-criticism underwent 10-12 sessions of emotion-focused therapy (EFT). Therapist responses focusing on emotions, thoughts, and actions were coded for two sessions (sessions 6-12) during the initial 10 minutes prior to chair work. Clients' emotional states were coded using the Classification of Affective Meaning States (CAMS) during the subsequent chair work. Self-criticism and depression were measured at pre-treatment, post-treatment, and 3-month follow-up.

Results: Primary maladaptive emotions and the transformational sequence (primary maladaptive followed by adaptive emotion) predicted reductions in self-criticism at post-treatment, with the transformational sequence also predicting improvements at follow-up. The impact of therapist focus on emotions on depression and self-criticism at post-treatment and follow-up was mediated by the transformational sequence.

Conclusion: The transformational sequence predicts therapeutic outcomes and mediates the impact of therapist responses focused on the client's emotion and therapeutic results. Implications for therapist training are discussed.

Objective: Routine Outcome Monitoring (ROM) in group psychotherapy has shown varied results, as personalizing therapy for multiple patients is challenging. This study explored the impact of ROM and individual Add-On Interventions (AOIs) for patients with depression who were not progressing during Group Cognitive Behavioral Therapy (GCBT). We followed the research question, "How can individual AOIs contribute to patients' therapy courses?".

Method: We interviewed patients and therapists involved in GCBT with ROM and individual AOIs prompted by Not-On-Track alerts. Thematic analysis was used to generate themes related to participants' experiences. Three cases were selected to illustrate the structure of the themes.

Results: The main theme, "AOIs: Potential for active engagement," was constituted by seven subthemes concerning the influence of ROM, therapeutic collaboration, shared decision-making, allowing for person-tailored interventions, and the dynamic between group and individual sessions. The potential for active engagement was nurtured through flexible awareness, as patients shifted between a first-person perspective and an external perspective on their therapy process.

Conclusion: Individual AOIs, prompted by patient feedback, could create opportunities for reflection and engagement. However, the impact was shaped by the therapeutic relationships, the shared decision-making process, and the extent to which the AOIs offered complementary approaches to group psychotherapy.

Objective: Dropout is a major factor undermining the effectiveness of psychotherapy, however, it remains poorly anticipated in clinical practice. Classification trees may offer simple, accessible, and practical solutions to identifying patients at-risk of dropout by synthesizing potentially complex patterns of relationships among intake measures.

Method: Intake variables were collected from day-patients who attended a Cognitive Behavior Therapy (CBT) group program at a private psychiatric hospital between 2015 and 2019. Based on these variables, two classification trees were trained and tested to predict dropout in (1) a weekly group, and (2) an intensive daily program.

Results: Dropout was lower in the intensive treatment (Weekly CBT = 21.9%, Daily CBT = 13.2%), however, in both programs, the number of comorbid diagnoses was the most important factor predicting dropout. Overall balanced accuracy was comparable for both tree models, with the Weekly CBT model identifying 63.18% of dropouts successfully, and the Daily CBT model identifying dropouts with 62.06% accuracy.

Conclusion: Findings suggest that comorbidity may be the most important factor to consider when assessing dropout risk in CBT, and that dropout can be predicted with moderate accuracy early in therapy via simple models. Furthermore, findings suggest that condensed, intensive treatments may bolster patient retention.

Objective: Maintaining relevance in a psychodynamic dialogue is a nuanced task, requiring therapists to balance between following patients' free associations while avoiding less effective interventions. Identifying less effective sequences of talk is especially challenging given the diversity of psychodynamic approaches and methodological barriers to analyzing session discourse. This study introduces a novel approach using the MATRIX coding system, an evidence-based tool, to differentiate content correlated with better session outcomes.

Method: Transcripts of 367 sessions were coded using the MATRIX. Therapist Out-of-MATRIX utterances, indicating a deviation from core therapeutic focus, were examined for their predictive value. Outcome measures included the next-session alliance and patient functioning scores. Two machine-learning-based models, using the Random Forest algorithm, predicted session-by-session changes in clinical outcomes based on MATRIX codes, and interpreted using the SHapley Additive exPlanations.

Results: Therapist Out-of-MATRIX utterances accurately predicted next-session changes in alliance and patient functioning scores. Our model also identified an optimal dose-effect relationship for the number of Out-of-MATRIX interventions needed for effective therapy session.

Conclusion: This study demonstrates the potential of using contemporary research tools to analyze therapeutic discourse, revealing how psychotherapy produces its benefits. Its scope extends beyond prediction, providing practical recommendations on how to enhance therapists' performance and outcomes.

Objective: Patients with Major depressive disorder (MDD) and a comorbid Borderline personality disorder (BPD) show a poorer prognosis for MDD compared to patients without BPD. Little is known about the therapeutic processes underlying this prognosis. The goal of the present study was to investigate whether patients with more severe BPD symptoms experience less strengthening in patient-therapist movement synchrony (MS) throughout treatment, and whether less strengthening in MS is associated with less effective sessions. Method: Ninety-five patients participating in a randomized control trial were assessed for BPD (N = 9) using the Structured Interview for DSM-IV Personality. 1367 video-taped sessions were analyzed for MS using Motion Energy Analysis. Session effectiveness was evaluated following each session using a one-item scale taken from the Helping Skills Measure. Multilevel models were used to assess whether BPD severity predicted MS throughout treatment, and whether MS predicted session effectiveness. Results: Patients with more severe BPD symptoms experienced greater strengthening in MS throughout treatment. Less MS strengthening was associated with less session effectiveness. Conclusion: These findings indicate unique therapeutic processes that characterize individuals with more severe BPD symptoms. Shedding light on these unique processes has the potential to contribute to the personalization of MDD treatment for patients with BPD.