Psychotherapy Research最新文献

Objective: This study aims to explore whether activity-preference alignment provides unique contributions to the working alliance and counseling outcomes beyond the client-rated adult attachment style, and to examine the moderating roles of behavioral and brain synchrony in this process.

Methods: Sixteen pairs of counselors and clients participated in five consecutive weekly counseling sessions. The 1st, 3rd, and 5th sessions took place offline in a near-infrared laboratory, while the 2nd and 4th sessions were conducted online via video conferencing.

Results: After controlling for the client-rated adult attachment style, preference alignment showed a significant impact on symptom improvement. Specifically, preference alignment had a significant positive predictive effect on symptom improvement when counselor-guided behavioral synchronization was high. Attachment avoidance also negatively predicted the working alliance but only when client-guided brain synchronization in the temporoparietal junction was low.

Conclusion: The study suggests that preference alignment provides unique insights into symptom improvement beyond client-rated attachment style alone. Counselor-guided behavioral synchrony amplifies the effect of preference differences on symptom improvement, whereas client-guided brain synchrony reduces attachment avoidance's impact on the working alliance. These findings highlight that behavioral and brain synchrony impact therapeutic outcomes differently based on who guides the process, emphasizing the need to consider both interpersonal dynamics and alignment factors in counseling.

Objective: Remission and recovery from borderline personality disorder (BPD) is difficult, yet achievable, yet not all people benefit. Peers with lived experience of recovery from BPD as co-therapists may increase engagement, reduce stigma and strengthen hopefulness. We evaluated a peer and clinician co-led group therapy (AIR Peers) for consumers with BPD.Methods: Eighty-three participants (88% female, M age = 36yrs) were randomized into either AIR Peers therapy (n = 43) or treatment as usual (TAU; n = 40). The intervention was co-designed by people with lived experience and clinicians. It involved 12 hours of group therapy over a 6-week period (2hrs/week). Weekly topics included discussion of stigma, self-compassion, self-care, creative recovery and "building your best life."Results: Intention to treat multilevel modeling analysis indicated that the AIR Peers group showed a significant reduction in BPD symptoms (primary outcome) and improvement in mental health ratings (secondary outcome), whereas no change was present in the TAU group. Self-report ratings indicated therapy success, helpfulness, and satisfaction. Quantitative and qualitative ratings of group and therapist alliance and group engagement were positive.Conclusion: Peer and clinician co-facilitated therapy groups may contribute to novel and effective approaches for people living with BPD on their recovery journey.Trial registrationAustralian New Zealand Clinical Trials Registry identifier: ACTRN12621000183886.

Objective: This study investigated group climate dynamics and their impact on social adjustment in therapy groups for youth. Method: A total of 536 children and adolescents who were significantly depressed compared to norms, participated in 95 therapy groups in Taiwanese schools. We employed dynamic structural equation modeling to analyze session-to-session associations of group engagement and conflict and their effects on weekly changes in social adjustment, as rated by group members and leaders. Results: Contrary to our hypothesis, no reciprocal association was found between engagement and social adjustment. However, previous session engagement (b = 0.81, 95% CI [0.553, 1.075]) and conflict (b = 1.14, 95% CI [0.825, 1.515]) were positively associated with current social adjustment in the current week. A negative association was identified between prior engagement and current conflict (b = -0.61, 95% CI [-0.923, -0.351]), while previous conflict positively influenced current engagement (b = 1.53, 95% CI [1.116, 2.029]), suggesting a negative feedback loop (e.g., high engagement leads to low conflict, which leads to low engagement, which leads to high conflict, which leads to high engagement) that maintains group climate stability. Conclusions: Group climate plays a crucial role in youth group therapy, influencing members' social adjustment and demonstrating a dynamic interplay that supports climate homeostasis.

Objective: Yalom (1985) believed that working in the here-and-now of the group is essential to facilitating the "therapeutic factors" necessary for a successful outcome. Yet, we currently lack research examining whether a here-and-now in-session focus predicts the therapeutic factors, as theorized.

Methods: This study used Linguistic Inquiry and Word Count (LIWC) analysis to assess group member and leader in-session here-and-now focus by analyzing words spoken in a session.

Results: The results suggest that when group leaders use more here-and-now words in a speaking turn, group members use more here-and-now words in the subsequent speaking turn. However, contrary to expectation, group leaders and group members "matching" on here-and-now language in a session did not predict more therapeutic factors in between sessions, but rather less social learning. Instead, how consistent or variable group members or leaders were in their here-and-now focus generally predicted more therapeutic factors.

Conclusion: These results suggest that LIWC may be a promising vehicle to assess here-and-now language in group therapy sessions and that a here-and-now in-session focus has a complex relationship with the therapeutic factors.

Objective: This study investigated whether therapists' level of professional self-doubt (PSD), in interaction with their internal relational models (i.e., their self-affiliation or attachment style), their experience level, and their professional coping strategies, impacted the alliance and symptom change in therapy.Methods: 555 clients (M_age = 42.8 years, 72.4% female) received individual psychotherapy from 54 psychologists. Associations between PSD, self-affiliation (in general and at its worst), avoidant and anxious attachment, years of experience, and constructive and avoidant-rejecting coping as predictors and moderators, and alliance or symptom change as outcomes, were analyzed using multilevel growth modeling.Results No direct effects of PSD, and no moderated effects between PSD and the therapist's internal relational models were found. However, higher PSD and more practice experience predicted steeper alliance growth in therapy, and higher PSD and more avoidant-rejecting coping predicted lower mid-therapy symptom levels.Conclusion: PSD generally did not exert a strong influence on the psychotherapy process and outcome. However, the significant interactions between PSD and experience level and avoidant-rejecting coping suggest that PSD may relate to alliance change amongst the most seasoned practitioners or could buffer against the negative effects of more avoidant therapist behaviors. These preliminary findings may inform future research on PSD.Trial registration: ClinicalTrials.gov identifier: NCT05630560..

Objective: This study examines whether patterns in the movement of topics during psychotherapy sessions can provide psychotherapists with actionable insights for single-case analysis. It utilizes both statistical models and AI-driven tools to uncover these dynamics. Method: We transcribed a completed psychotherapy session comprising 26 sessions. First, common topics across all therapies were identified, and then expert psychotherapists labelled each conversational turn of this selected psychotherapy. As determined by the experts, the topic dynamics were analysed using Generalized Additive Mixed Models (GAMMs), which captured non-linear trends and hierarchical structures within the data. Subsequently, these trajectories, as identified by the experts, were compared with the topics extracted in an unsupervised manner using a topic modelling algorithm, called Latent Dirichlet Allocation (LDA). Results: Our findings confirm that topic trajectory analysis reliably indicates therapeutic progress. Specifically, topics related to suffering (SPS) decreased over time, while topics concerning therapeutic refiguration and insight (TRI) increased, reflecting clinical improvement. Conclusion: The study demonstrates that both GAMMs and LDA are useful tools to see how the topics in specific psychotherapy are modified their occurrence during the therapeutic work. Combining classical methods of statistical analysis and AI-driven topic analysis enhances the sensitivity of assessments, providing insights into how the psychotherapy work changes across sessions.

Objectives: Existing research suggests that a psychotherapist's physical attractiveness can shape patients' initial evaluation. However, less is known about how facial attractiveness affects the decision to select one psychotherapist over another prior to therapy. In this study, conducted with a Spanish-speaking sample (N = 108, 63 females, M_age = 32.08 years, SD = 17.50), we examined whether facial attractiveness influenced the likelihood of choosing a psychotherapist and whether this effect was moderated by sexual differences.Methods: The experimental design closely replicated an online professional therapist directory to enhance ecological validity. Participants were instructed to rate the likelihood of selecting each individual as their therapist.Results Results demonstrated that psychotherapists with attractive facial features were chosen more frequently, even when perceived trustworthiness and competence were controlled for. No significant differences were observed between profiles featuring unattractive faces and those with no profile picture. Crucially, neither the therapist's nor the patient's gender and sexual preferences (i.e., sexual attraction) moderated the observed effect.Conclusion: The findings suggest that the preference for attractiveness in therapist selection is not driven by mating intentions nor by a "halo effect" related to trustworthiness or competence. Practical implications for therapist selection and patient decision-making are discussed.

Objective: This study aims at developing empirically driven criteria for correlational effect size interpretations grounded on the actual psychotherapy process-outcome effect size distributions. Method: We performed a meta-analysis on PubMed and PsycINFO databases searching for meta-analyses reporting correlational process-outcome associations. Results: Forty-three meta-analyses met inclusion criteria, reporting 1,637 effect sizes from 859 unique studies. A four-level meta-analytic model resulted in an estimated mean effect size of r = .24 (z = .24, 95% CI[.22,.27]), significantly different from Cohen's proposed value for moderate effects (i.e.,.30), z = -.04, SE = 0.01, t(1628) =  -4.17, p < .001). Percentiles derived from the models showed that Cohen's criteria were too conservative, with the 25th percentile = .12, 50^th percentile = .26, and 75^th percentile = .39. Based on these findings, we suggest the benchmarks .10, .25, and .40, for small, moderate, and large effect sizes. Even when using these less restrictive criteria, the majority of the correlation analyses from primary studies (81.8%) were underpowered to identify at least a moderate effect size. Conclusion: The current findings might help to enhance effect size interpretations and power calculations in psychotherapy process-outcome research. Further replications are necessary to extend these benchmarks to other areas of clinical psychology.

Objective: Cognitive perceptual disruption (CPD) is an emotion regulation mechanism described in intensive short-term dynamic psychotherapy (ISTDP) that distinguishes fragile patients from resistant ones. CPD functions as an involuntary avoidance-based mechanism that prevents engagement with distressing emotions, making its identification crucial for guiding treatment. Currently, CPD assessment relies solely on clinical psychodiagnostic evaluation, with no available psychometric instruments. This study introduces a cognitive perceptual disruption screening instrument (Copeds), a self-report measure designed to identify CPD and assist in treatment planning for emotion-focused therapies.

Method: A cross-sectional study was conducted to develop Copeds, evaluate its ability to distinguish between fragile and resistant patients, and examine its preliminary psychometric properties. 112 outpatients underwent clinical psychodiagnostic evaluation and completed Copeds. Regularized regression techniques, receiver operating characteristic (ROC) analysis, and analyses of internal consistency and sensitivity/specificity were performed.

Results: The final instrument contained 19 psychometric items that strongly discriminated between fragile and resistant patients. ROC analysis yielded an area under the curve (AUC) value of 0.88. Sensitivity was 91.4%, and specificity was 76.4%.

Conclusion: The study provides promising initial evidence for Copeds as a reliable instrument with strong classification accuracy, supporting its potential use in clinical assessment and treatment planning for emotion-focused therapies.

Objective: Borderline personality disorder (BPD) is characterized by emotion dysregulation and relationship dysfunction. However, the majority of BPD treatments provide individually-focused treatment and do not target relationship functioning or include significant others. The current paper presents the primary and secondary outcomes from an uncontrolled trial of Sage, a manualized conjoint treatment for people with BPD and their intimate partners that targets BPD, relationship conflict, and partner mental health simultaneously. Method: Sixteen couples wherein one member has BPD and elevated suicidal ideation/chronic and frequent suicidal/self-injurious behavior were enrolled in the 12-session Sage protocol. Measures of BPD severity (including suicidal ideation, suicidal/self-injurious behaviors, and emotion dysregulation) and relationship outcomes were collected at pre-, mid-, and post-intervention, and three-month follow-up. Results: Self-reported BPD severity, suicidal ideation, and emotion dysregulation and interview-rated frequency of suicidal and self-injurious behaviors improved from baseline to follow-up. No changes were observed in relationship outcomes or informant-reported BPD severity and suicidal ideation. Conclusions: These findings suggest that Sage may aid in improving BPD pathology with moderate to large effect sizes. The lack of improvements in relationship outcomes may be due to the relatively high relationship functioning observed in couples at baseline, but more testing is needed.Trial registration: ClinicalTrials.gov identifier: NCT04737252..