Psychotherapy Research最新文献

Background: Emotion-Focused Therapy is one of the evidence-based psychotherapies for a range of psychological problems. While most evidence was gained from randomized controlled studies or process research at university settings, there is a need for more outcome research conducted within practitioner-researcher networks assessing the effectiveness of Emotion-Focused Therapy in private practice.

Methods: A total of N = 70 clients with a variety of psychiatric disorders have been included in the bi-national practitioner researcher network for Emotion-focused Therapy Switzerland-Germany. Symptom change was assessed using CORE-OM, BDI-II, IIP and WSAS. Therapist adherence was assessed by the self-reported version of the PCEPS. Pre-post-follow-up analyses were conducted using paired sample t-tests and hierarchical linear modeling.

Results: Pre-post-assessment shows small to medium effect sizes for all outcome measures (except for interpersonal problems which did not change). Symptom reduction is maintained for CORE, BDI and WSAS, and increased for IIP at 3 and 6 months follow-up. Therapist adherence is good to excellent in this sample.

Conclusions: Emotion-Focused Therapy is effective in the real-world practice, as suggested by the small to moderate effect sizes. The smaller effects found in the current study as compared to randomized controlled trials are consistent with the literature and suggest that EFT remains moderately effective when applied in a naturalistic context.

Objective: Cognitive behavioral therapy (CBT) and Emotion-focused therapy (EFT) are empirically supported models for treating depression. Comparisons of the models regarding outcome exist, but no comparison of the clients' experiences of change. This study explored and compared experiences of change in CBT and EFT for major depression.

Method: We conducted a comparative thematic analysis of the experiences of 28 clients after 12-18 sessions of either CBT (n = 14) or EFT (n = 14).

Results: The analysis resulted in five themes reported across treatments: (1) Changing the understanding of my problems; (2) Finding a new way to relate to inner experiences; (3) Changing how I see myself; (4) Challenging problematic ways of being with others; (5) Bringing changes into everyday life. Across treatment modalities, the clients experienced the same types of changes. Compared to EFT clients, more CBT clients emphasized the importance of practicing new strategies when facing adversity in their change process. Reversely, more EFT clients emphasized getting in touch with, tolerating, and listening to their inner experiences.

Conclusion: Our findings suggest that clients undergoing CBT and EFT describe changes in the same domains but show differences in how they emphasize various pathways leading to their change.

Objective: Teletherapy via videoconferencing has become common practice but has unique challenges. We aimed to develop and validate the first performance-based observer-rated measure of teletherapy skills: The Teletherapy Facilitative Interpersonal Skills Performance Task (Tele-FIS). Methods: We developed a set of 12 Tele-FIS video stimulus clips as simulations of four research-informed common therapeutic challenges in teletherapy: technology, distraction, boundaries and privacy, and emotional disconnection. A total of 153 therapists recorded interventions to the clips which were later rated on interpersonal skills. Results: The Tele-FIS performance task demonstrated good interrater reliability, internal consistency, test-retest reliability, and convergent validity. The Tele-FIS was positively associated with self-reported facilitative interpersonal skills, self-efficacy, attitudes towards technology, and observer-rated skills on a version of the FIS task that simulates in-person therapy. Therapists performed similarly on teletherapy clips of emotional disconnection and privacy issues compared to clips of in-person therapy. Therapists performed worse on Tele-FIS clips of technology and distraction challenges than in-person therapy clips. Conclusions: The Tele-FIS has potential as an assessment tool in skills training for trainees and licensed clinicians as well as future research about therapeutic work via teletherapy. Results are discussed to consider therapist skill and the use of practice-relevant materials in training.

Objectives: High levels of change are linked to the flexibility between immersion and distancing, as well as to higher levels of therapeutic alliance. This study aims to explore the evolution of flexibility between immersion and distancing throughout the entire therapeutic process and its relationship with therapeutic alliance and depressive symptoms in a clinical case.

Method: We analyzed five sessions of a good outcome case of depression undergoing cognitive-behavioral therapy. We assessed the distancing/immersion of these sessions using the Measure of Immersed and Distanced Speech, and therapeutic alliance with the Working Alliance Inventory-Short Form. The depressive symptoms were assessed from the Beck Depression Inventory-II.

Results: Flexibility and therapeutic alliance from both client's and therapist's perspectives increased throughout the therapeutic process. A strong negative correlation was found between flexibility and depressive symptoms.

Conclusions: The increase in flexibility can be an adaptive pattern associated with the decrease in depressive symptoms, the increase in therapeutic alliance (from both the client's and the therapist's perspective), and therapeutic success.

Objective.: There is a growing consensus that interpersonal processes are key to understanding psychotherapy. How might that be reflected in the brain? Recent research proposes that inter-brain synchrony is a crucial neural component of interpersonal interaction. The current proof-of-concept study examines, for the first time, therapist-patient inter-brain synchrony measurement during multiple sessions. To guide the design of future studies, we performed a precursory test in a small sample of the association between inter-brain synchrony and therapeutic change, hypothesizing that it would gradually increase over therapy, reflecting inter-brain plasticity.

Method.: We scanned 18 therapy sessions of participants (N = 8) who underwent a 6-session test anxiety treatment. We measured therapist and patient brain activity using functional near-infrared spectroscopy (fNIRS) and assessed perceived session quality, wellbeing, symptoms, and therapeutic alliance every session.

Results.: In this proof-of-concept sample inter-brain synchrony gradually increased over treatment, and was associated with reduced symptoms, improved wellbeing and perceived session quality, but not with a stronger therapeutic alliance. fNIRS imaging had no discernable adverse effects.

Conclusion.: Our findings demonstrate that fNIRS imaging during psychotherapy is a feasible and viable research method and that inter-brain plasticity should be a candidate for future research on biological mechanisms underlying therapeutic change.

Objective: This study applied a mixed-methods approach to investigate rater effects that might affect case report evaluation in China. Method: In the quantitative phase, we randomly assigned 210 mental health professionals to the experienced or novice ratee condition to rate the same structured case report on assessment and formulation, intervention strategy, relationship, and self-reflection. The qualitative phase was subsequently conducted to help make sense of the results. We interviewed twelve supervisors about how they would rate a case report and factors they thought would influence their evaluation. Results: Linear model with non-constant variances revealed that the manipulation of ratee experience did not significantly bias ratings. Raters whose self-identified theoretical orientation aligned with that of the report provided higher and less dispersed ratings for intervention strategy and therapeutic relationship competencies. As their years of experience increased, theoretically congruent raters tended to give lower and more dispersed ratings. Thematic analysis revealed highly variable cognitive processes, and identified rater theoretical expertise, evaluation context, rater subjectivity and dual relationships as important factors to consider. Conclusion: This study indicate that theoretically congruent raters would be desirable, but raters with more years of experience should be cautioned against giving stringent ratings for theoretically familiar cases.

Objective: There is a growing interest in idiographic patient-reported outcome measures (I-PROMs) for routine outcome monitoring (ROM) and clinical feedback (CF) in psychotherapy, but to our knowledge, no systematic reviews of the empirical literature. Method: We conducted a systematic literature search for empirical papers investigating effects and experiences of I-PROMs for ROM/CF and found a total of 13 papers. There was only one experimental controlled effectiveness study. Results: We formulated a narrative summary of the data set as a whole. We conducted a secondary analysis of nine papers containing qualitative data on stakeholder experiences with I-PROMs and found three superordinate themes and eight subthemes, summarized as "I-PROMs can facilitate self-reflection for patients, assist in identifying and tracking therapeutic topics, and make patients more committed to therapy by giving them a greater sense of responsibility and empowerment. Formulating goals and problems can be difficult, and lack of progress can be demotivating. Time in therapy is precious and must be spent wisely. Effective use of I-PROMs is facilitated by flexibility and therapists' use of clinical skills." Conclusion: We discuss the limitations of the study and provide recommendations for future research and clinical practice.

This paper provides an overview of my research programme for the past 37 years. The focus of my work has been on identifying productive in-session processes to enhance treatment outcomes and therapist responsiveness. Two foci will be reviewed, first, my research on client and therapist interpersonal process and second, productive processing in psychotherapy in three different therapeutic approaches including EFT, CBT and CCT. Given that many competing theoretical perspectives are effective, I was curious about change processes that are common and unique to each. In my work, I employed a variety of research methodologies drawing on frameworks with alternative epistemological and ontological assumptions to capture specific in-session change processes in an attempt to reveal the richness and complexity of the phenomena being studied and illuminate the process of change.

Background: Psychotherapy is a key evidence-based method for the treatment of mental disorders. However, little research has been published on the negative effects of psychotherapies. Aims: We examined this issue through a systematic literature review of previous systematic reviews on randomized controlled trials (RCTs). Methods: We focused on previous reviews and meta-analyses on 1) RCTs examining the effectiveness of psychotherapies and 2) previous reviews and meta-analyses specifically focusing on the negative effects of psychotherapy. We included publications published in PubMed and the Cochrane Databases from the year 2000 or later. Results: Of the 1,430 relevant publications, only a small proportion (30%) mentioned negative outcomes, mostly withdrawal. Only 57 of the extracted original studies monitored potential negative effects, and only three small-scale studies indicated negative effects. Conclusions: The systematic monitoring of negative effects in psychotherapy has not been given the same attention as has been given to the benefits of therapy.