Psychotherapy Research最新文献

Objective: This study examined the association between the rupture-repair process and patients' and therapists' perceptions of the therapist's responsiveness.

Method: We used the Rupture Resolution Rating System to rate early sessions (3-5) in 35 short-term psychodynamic psychotherapy cases. The patients and therapists rated their perceptions of the therapist's responsiveness after each session using the Patient's Experience of Attunement and Responsiveness (PEAR) Scale.

Results: Therapists' contribution to ruptures was negatively associated with both patients' and therapists' PEAR ratings. Confrontation ruptures were negatively associated with patients' PEAR ratings, whereas there was no significant association with withdrawal ruptures. Resolution was positively associated with both patients' and therapists' PEAR ratings. In addition, resolution moderated the negative association between ruptures and patients' PEAR ratings.

Conclusion: The findings emphasize the link between therapists' responsiveness and the rupture-repair process. They also highlight the significance of providing therapists with the necessary training to recognize these dynamics and engage in discussions about them with their patients when appropriate.

Objective: Evidence about the high burden of depression on society and the immediate environment of patients has accumulated over the past decades. Yet, empirical data about the impact of depression on the environment of psychotherapy are limited. The present study investigates the phenomenon of therapist responsiveness in the treatment of depression. Specifically, this qualitative study examines the influence of a client's severe depressive symptomatology on psychotherapists' immediate experience and reflections about interventions.

Method: The responses of 26 Flemish psychotherapists and counselors to a questionnaire with open questions and as part of a focus group were investigated by using Consensual Qualitative Research methodology.

Results: First, experiences with a negative valence were most common in the responses of the psychotherapists and counselors. A particular negative experience, a sense of "constriction", affecting the therapist's relational, cognitive, emotional, and bodily level of experiencing, was a predominant response. Second, most psychotherapists and counselors considered a therapeutic attitude of being present for the client and the different aspects in the client's experience to be crucial, although most of them experienced difficulty in maintaining an attitude of presence.

Conclusions: The results of this study suggest that exploration of the different aspects of the clients' experience and working with the self-split of the client might be essential in the psychotherapeutic treatment of depressive disorder.

Therapist responsiveness denotes that therapists provide therapeutic interventions within an emerging context of client manifestations and moment-by-moment internal and external changes. So far, psychotherapy research on explaining how therapy works falls short of operationalizing the sequence of events constituted by therapist responsiveness. The present special section of Psychotherapy Research addresses this conceptual and methodological gap and proposes six original contributions, using several validated assessment protocols, both from a quantitative and qualitative viewpoint, to study therapist responsiveness in psychotherapy. It aims at providing a rigorous conceptual and methodological basis for studying a core principle of change in psychotherapy for the future.

Objective: To assess and compare the frequency of psychotherapeutic side effects in different psychotherapeutic approaches.

Method: Side effects were assessed across 17 domains through structured interviews with 45 outpatients in cognitive-behavior, psychodynamic, and psychoanalytic psychotherapy.

Results: Almost every patient (95.6%) reported at least one side effect, with a mean of 4.7 affected domains. Most frequent complaints were that problems were seen as more complex (60.0-80.0%), worsening of pre-existing symptoms (46.7-60%), occurrence of new symptoms (20.0-53.3%), feeling uncomfortable in treatment (33.3-40.0%), tensions with therapist (26.7-46.7%), as well as conflicts with current family and with family of origin (both 13.3-46.7%). Differences between therapeutic orientations were mostly non-significant.

Conclusion: Psychotherapy is regularly accompanied by side effects, independent of different theoretical orientations. Psychotherapists need to be familiar with side effects in order to inform patients about treatment-associated risks and to recognize and manage side effects.

Objective: The present paper focuses on therapist responsiveness during the initial therapy session with clients with borderline personality disorder (BPD), aiming to analyze therapist responsiveness at short intervals during the initial session and determine if it can predict therapeutic alliance from both therapist and client viewpoints.

Method: A sample of 47 clients participated in the study for 10 sessions of therapy. Therapeutic alliance from therapists' and clients' perspectives was rated after each session; external raters assessed therapist responsiveness during the initial session. Multiple linear regression models and linear mixed models with backward variable selection based on AIC were run to analyze whether specific therapist behaviors during session one predicted therapeutic alliance rated from therapists' and clients' perspectives.

Results: The results indicate that therapists normalizing and validating clients' experiences during the first session are crucial for establishing therapeutic alliance for BPD clients; however, for therapists, the increase in variability of emotions verbalized by clients during the initial session negatively impacts therapeutic alliance.

Conclusion: The study contributes to further understand the impact of therapists' behavior at the beginning of therapy with BPD clients. Therapist responsiveness is crucial for therapy outcome but is methodologically challenging; therefore, efforts in this direction should be pursued.

Objective: No systematic review was identified investigating the influence of perceived therapist credibility on treatment outcomes. Extant treatment credibility reviews have focused on early perceptions without considering influence of various therapy phases. This study aimed to examine the relationship between perceived treatment and therapist credibility and treatment outcomes, while considering the timing of the credibility assessment as a potential moderator.

Method: Articles published in English peer-reviewed journals containing at least one quantitative measure of credibility and treatment outcome regarding face-to-face therapist-delivered interventions were eligible. PsycINFO, MEDLINE and Embase online databases were last searched on April 5th, 2023, and the Effective Public Health Practice Project tool was used to assess the study quality. Correlations between treatment credibility and outcomes, and therapist credibility were calculated separately.

Results: Analysis of 27 studies revealed a positive association between perceived treatment credibility and treatment outcome (r = 0.15,95%CI = 0.09,0.21,p < 0.001,n = 2061). Nine studies showed a strong association between perceived therapist credibility and outcome (r = 0.35,95%CI = 0.18,0.51;p < .001,n = 1161). No significant moderator found in both meta-analyses.

Conclusion: Findings suggest that clients' perceptions of higher credibility - whether concerning the treatment or the therapist - are associated with better therapeutic outcomes. Constraints in inclusion criteria and the small sample size in eligible studies were notable limitations.

Objective: Therapists' emotional responses play a significant role in the therapeutic relationship and in the therapy process. The current study examined the associations between therapists' emotional responses before and after therapy sessions, and patients' experience of them as attuned and responsive.

Method: Forty patient-therapist dyads participated in 16 weekly sessions of Supportive Expressive Psychotherapy. Therapists' emotions were assessed on the Feeling Word Checklist-58. We examined one positive feeling (Parental) and one negative feeling (Inadequate) Following each session, patients and therapists rated responsiveness on the Patient's Experience of Attunement and Responsiveness.

Results: Feeling Parental before sessions was associated with patients' post-session ratings of therapist empathy, but not with session helpfulness or sensed achievement. Therapists' feelings of inadequacy before sessions were negatively associated with patients' ratings of helpfulness and achievement, but not with empathy. Therapists' Parental feelings after the session were positively associated with patients' ratings and their own ratings on all 3 PEAR subscales. Feeling Inadequate after the session was negatively associated with patients' ratings of helpfulness, achievement and empathy. Therapists' ratings were only negatively associated only with helpfulness.

Conclusion: The study demonstrates that therapists' emotional reactions play a role in their patients' experience of their responsiveness.

Objective: To explore how patients and therapists in an outpatient specialized substance use disorder treatment setting experienced the first treatment session, and to identify relational facilitators and barriers seen from both patient and therapist perspectives. Method: The study is based on a qualitative approach and semi-structured interviews of patients (n = 12) and therapists (n = 12). Interviews were conducted soon after the first treatment session and analyzed in accordance with reflexive thematic analysis. Results: We identified subthemes for patients and therapists, respectively. In addition, we found that patients and therapists described certain comparable experiences and actions which we integrated as core themes: (a) feeling uncertain about what to expect; (b) forming first impressions; (c) balancing multiple concurrent concerns; (d) seeking feedback from the other; and (e) sensing a way forward. The subthemes specify patients' and therapists' unique meanings and approaches to each core theme. Finally, we summarized unique and shared relational facilitators and barriers. Conclusion: Patients and therapists use the first session to form an impression of the other, but they are also concerned with the impression they themselves give. They, therefore, monitor the other's in-session reactions and responses which constitute facilitators or barriers for their own further relational actions.

Objective: Social psychological research has indicated that people strive for self-consistent feedback and interactions, even if negative, to preserve the epistemic security of knowing themselves. Without such self-verification, any interpersonal exchange may become frustrated, anxiety-riddled, and at risk for deterioration. Thus, it may be important for therapists to meet patients' self-verification needs as a responsive precondition for early alliance establishment and development. We tested this hypothesis with patients receiving cognitive behavioral therapy for generalized anxiety disorder-a condition that may render one's self-verification needs especially strong. We also tested the hypothesis that better early alliance quality would relate to subsequent adaptive changes in and posttreatment level of patients' self-concepts.

Method: Eighty-four patients rated their self-concepts at baseline and across treatment and follow-up, their postsession recollection of their therapist's interpersonal behavior toward them during session 2, and their experience of alliance quality rated after sessions 3-6.

Results: As predicted, the more therapists verified at session 2 a patient's baseline self-concepts (which trended toward disaffiliative and overcontrolling, on average), the more positively that patient perceived their next-session alliance. Moreover, better session 3 alliance related to more adaptive affiliative and autonomy-granting self-concepts at posttreatment.

Conclusion: Results are discussed within a therapist responsiveness framework.