Psychotherapy Research最新文献

Objective: This study aimed to translate the Rupture Resolution Rating System (3RS) and the Working Alliance Inventory -Observer Short Form (WAI-O-S) into Italian. As a preliminary step toward validation, inter-rater reliability and convergent validity of the translated measures were also examined.

Method: First, forward-backward translation process was conducted to ensure conceptual and linguistic equivalence with the original English versions. Second, four trained raters independently applied the Italian versions of the 3RS and WAI-O-S to 47 psychotherapy sessions involving 20 different patients. Finally, inter-rater reliability (IRR) and convergent validity were analyzed.

Results: This study produced the first Italian versions of the 3RS and WAI-O-S, providing conceptually robust tools to assess therapeutic alliance and rupture-repair processes. Preliminary analyses showed acceptable inter-rater reliability for both measures, though some variability emerged in certain 3RS dimensions-particularly Therapist Withdrawal and Repair. Strong correlations between the 3RS Working Together score and the WAI-O-S total score offered preliminary evidence of convergent validity.

Conclusion: These preliminary findings provide initial support for the reliability and validity of the Italian 3RS and WAI-O-S. Further studies in larger and more diverse samples are necessary to examine their generalizability and clarify their applicability.

Objective: The aim of this study was to identify therapist characteristics associated with effective rupture resolution processes. We examined the association between therapists' experience of professional self-doubt (PSD) and the resolution of alliance ruptures.

Methods: Data from 4,986 sessions of 535 clients treated by 53 therapists in a primary care setting were analyzed. The interaction between rupture occurrence and therapists' levels of general (state-like) or session-related (trait-like) PSD on alliance change was analyzed using multilevel modeling. Additionally, the moderating role of therapists' feelings of inadequacy on this interaction was investigated.

Results: A significant interaction between rupture occurrence and the quadratic term of trait-like PSD was found, with both higher and lower levels predicting lower client alliance ratings after ruptures. Additionally, increased state-like PSD during ruptures led to improved client alliance ratings among therapists with lower feelings of inadequacy.

Conclusion: The results contribute to a more refined understanding of the effect of therapist characteristics on rupture resolution, indicating that moderate levels of trait-like PSD are optimal, and state-like PSD effects depend on therapists' feelings of adequacy.

Objective: This study explores the experience of an individual and family therapy youth suicide intervention from the perspectives of seven psychotherapy triads (young people aged 12-18, their parents/caregivers and therapists). Method: Data were collected through semi-structured individual interviews and analyzed using consensual qualitative research methods. Results: Four domains were identified: Focusing on the youth-parent relationship, individual therapy for young people and their parents, conjoint therapy, and public service structures and systemic practice that facilitated tailored treatment. All participant groups valued intervention that improved the youth-parent relationship; however, they held different views about its influence on suicidality and recovery. Separate youth and parent therapy was crucial for facilitating the tailoring of treatment and enhancing the reparative potential of conjoint therapy. Barriers to productive intervention included inaccessible, fragmented, and siloed treatment that excluded parents, stigmatizing clinician responses, and acute care that was not attuned to need or developmental context. Helpful intervention was systemically and attachment-informed, multi-disciplinary, individually tailored, and integrated freely available specialist therapy with crisis and inpatient care. Conclusion: A relational, nuanced, and flexible approach is needed to tailor youth suicide treatment in the context of the complexity of youth-parent relationships.

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: With meta-analytically estimated rates of about 25%, dropout in psychotherapies is a major concern for individuals, clinicians, and the healthcare system at large. To be able to counteract dropout in psychotherapy, accurate insights about its predictors are needed. Method: We compared logistic regression models with two machine learning algorithms (elastic net regressions and gradient boosting machines) in the prediction of therapy dropout in two large inpatient samples (N = 1,691 and N = 12,473) using baseline and initial process variables reported by patients and therapists. Results: Predictive accuracies of the two machine learning algorithms were similar and higher than for logistic regressions: Therapy dropout could be predicted with an AUC of .73 and .83 for Sample 1 and 2, respectively. The initial evaluation of patients' motivation and the therapeutic alliance rated by the respective therapist were the most important predictors of dropout. Conclusions: Therapy dropout in naturalistic inpatient settings can be predicted to a considerable degree by using baseline indicators and therapists' first impressions. Feature selection via regularization leads to higher predictive performances whereas non-linear or interaction effects are dispensable. The most promising point of intervention to reduce therapy dropouts seems to be patients' motivation and the therapeutic alliance.

Objective: The purpose of the present study was to develop a brief version of the Cultural Humility Scale (CHS; Hook, J. N., Davis, D. E., Owen, J., Worthington, E. L., Jr., & Utsey, S. O. (2013). Cultural humility: Measuring openness to culturally diverse clients. Journal of Counseling Psychology, 60(3), 353-366. https://doi.org/10.1037/a0032595) to reduce participant burden in clinical settings.Method: In Study 1 (n = 247), we used confirmatory factor analyses (CFA) and two-factor item response theory (IRT) models to create the Cultural Humility Scale-Short Form (CHS-SF). In Study 2 (n = 272), we performed cross-validation of the CHS-SF. We also examined construct validity using the Cross-Cultural Counseling Inventory-Revised (CCCI-R; LaFromboise, T. D., Coleman, H. L. K., & Hernandez, A. (1991). Development and factor structure of the Cross-cultural Counseling Inventory-Revised. Professional Psychology: Research and Practice, 22(5), 380-388. https://doi.org/10.1037/0735-7028.22.5.380) and the Working Alliance Inventory (WAI; Tracey, T. J., & Kokotovic, A. M. (1989). Factor structure of the Working Alliance Inventory. Psychological Assessment: A Journal of Consulting and Clinical Psychology, 1(3), 207-210. https://doi.org/10.1037/1040-3590.1.3.207).Results: The CHS-SF has two 3-item subscales (positive/negative cultural humility). The CFA for the CHS-SF showed excellent model fit, and all coefficients demonstrated good-to-excellent reliability for the whole scale. The factor structure was replicated with a unique sample, and we also found evidence of measurement invariance by gender and race/ethnicity. The CHS-SF again showed adequate estimates of reliability. The CHS-SF was positively correlated with both the CCCI-R and WAI.Conclusion: The CHS-SF offers an efficient tool for measuring therapists' cultural humility based on client perceptions during treatment. Like the original CHS, it is well-suited for routine care and training environments. Implications for practice and research, limitations, and directions for future inquiry are discussed.

Objective: Therapeutic alliance has been little investigated in infant and toddler therapy, with no tools specifically adapted to this population. However, we have developed the Infant-Toddler Working Alliance Inventory-Short form (IT-WAI-S) which is based on the Working Alliance Inventory. The aim of this study was to assess the psychometric properties of this original French tool, in its two versions: for parent (IT-WAI-SP) and for therapist (IT-WAI-STh).Method: This study included 227 families consulting with their 18-48-month-old child for emotional or behavioral disorders. The scales were filled in at the first three therapy sessions. The IT-WAI-S acceptability, internal validity, reliability and predictive validity (association with child and mother's outcomes) were evaluated.Results: Confirmatory then exploratory factor analyses revealed a three-factor structure for the both scales: Negative Experience of Care Relationship, Positive Alliance and Alliance with the Child. Acceptability, reproducibility and construct validity were satisfactory for both versions. The two versions predicted the child's outcome. The IT-WAI-SP predicted also the mother's outcome. The IT-WAI-STh gave more reproducible results, whereas the IT-WAI-SP was a better predictor of the child's progress.Conclusion: The two IT-WAI-S versions showed good psychometric properties and could be used to study the therapeutic alliance in young children.

Objective: Negative effects of psychotherapy are a broad term that encompasses events such as non-response, deterioration, and novel symptoms. The aim of the present study was to explore experiences with negative effects among clinicians working within an intensive short-term dynamic psychotherapy (ISTDP) framework.

Method: Eight ISTDP clinicians consented to participate and were interviewed using semi-structured video interviews. Data were transcribed and analyzed using a reflexive thematic analysis framework.

Results: The thematic analysis resulted in five themes. Overall, the clinicians found it difficult to define negative effects, but that negative effects, regardless of cause, could be used therapeutically. Inaccurate assessment was seen as the main cause of negative effects. Other themes concerned the connection between dropout and negative effects, patient feedback, and the ISTDP community's relationship to negative effects.

Conclusions: The results are largely in line with qualitative studies of CBT clinicians' views of negative effects although clinicians in the present study emphasized more strongly the therapeutic potential of these events. The research field could be further improved by using mixed-method designs while including both patients and therapists.

Objectives: The Therapist Work Involvement Scales (TWIS) is a self-report research instrument that enables a multilayered description of psychotherapists' experiences when treating clients. The TWIS was created in a comprehensive study of close to 5,000 psychotherapists, and has been used in multiple studies. The aim of the current paper is to clarify the organization and statistical characteristics of the TWIS, and to present an updated version for longitudinal and cross-sectional research.

Methods: Collection of a large sample of psychotherapy trainees made possible the use of confirmatory factor analysis (CFA) to evaluate the dimensions and structure of therapists' process experiences, assessing reliabilities, measurement invariance over gender, item statistics, and correlations with other measures to show concurrent and predictive validity.

Results: The CFAs largely confirmed the factor structure of four of the five facets, and of the global super-factors. The global factors of Healing Involvement and Stressful Involvement each showed substantial correlations with therapists' attachment style and professional growth, and were used to describe four practice patterns that typify the experiences of therapists.

Conclusion: The results have shown the TWIS to be a statistically sound, multidimensional research instrument enabling therapists to describe their experience in current therapeutic work.

Objective: Early improvement predicts good outcome in psychotherapy for eating disorders. Prior studies have examined change in body mass index (BMI) or Eating Disorder Examination Questionnaire scores (EDE-Q) as indicators of early response, but not both simultaneously. Little research has examined early change among Anorexia Nervosa (AN) samples treated with eating disorder-focussed cognitive behavioural therapy (CBT-ED). We studied the process of early change in a fine-grained way to better understand whether early response predicts later response and post-treatment outcomes in CBT-ED for AN, and how the changes in EDE-Q and BMI are related. Method: Adults (N = 193) diagnosed with AN were treated with outpatient CBT-ED. We used bivariate Latent Change Score models to examine change in BMI and EDE-Q and relations between them. Results: Early change in BMI was independent of early change in EDE-Q. Larger changes in EDE-Q over the first five weeks of therapy followed smaller ones over the next five weeks, meanwhile smaller changes followed larger ones. Early change was predictive of post-treatment scores. Conclusion: Early change in BMI and EDE-Q during CBT-ED appear to be unrelated and follow different trajectories. Therefore, individuals declared as early responders may differ depending on which variable is used for the decision.