Psychotherapy Research最新文献

Objective: Patients with epistemic mistrust struggle to view others as trustworthy sources of knowledge and often default to negative appraisals in social communication. The three communication systems theory posits that resolving epistemic mistrust involves three systems: the epistemic match, improving mentalizing, and the re-emergence of social learning outside therapy. This study aimed to empirically examine the theory to understand how epistemic trust develops in psychotherapy.

Method: Using a theory-building case study approach, we analyzed therapeutic processes in six depressed adolescents (Mage = 16.58, SD = 1.17) with varying treatment outcomes. Sixty-six audiotaped psychotherapy sessions were reviewed to compare good- and poor-outcome cases, identifying patterns within therapeutic interactions.

Results: Findings provide the first empirical evaluation of the three communication systems theory, offering concrete examples of how it unfolds in clinical practice and suggesting refinements in therapist and patient processes to build epistemic trust. Additional insights into the theory highlight an early "window of opportunity" to foster epistemic openness, the influence of environmental factors outside therapy, and the interactive nature of therapist-patient dynamics.

Conclusion: This study refines the theoretical understanding of epistemic trust in psychotherapy, revealing specific therapist and patient behaviors that may facilitate its development. Implications for clinical practice and future research directions are discussed.

Objective: Several studies have identified therapist cultural humility as an important predictor of client psychotherapy outcomes, yet most have been conducted cross-sectionally, retrospectively, and/or with inconsistent assessment of other related therapy process constructs. Here, we bridge this gap by examining early treatment ratings of therapist cultural humility, multicultural competence, working alliance, and client-centered treatment approaches as prospective predictors of client functioning in an active community clinic.

Method: Fifty participants (56% women, 10% gender diverse; 44% ethnoracially diverse), aged 18-69, rated these factors within 12 weeks of intake in a community mental health clinic. Therapists assessed client functioning at pre-treatment screening, diagnostic feedback, and treatment termination.

Results: Multilevel modeling analyses indicated clients rating higher therapist cultural humility in early treatment had the largest improvements in therapist-rated functioning from pre-treatment to termination. Notably, the association between therapist cultural humility and client functioning at termination was moderated by ethnoracial status, with higher cultural humility ratings predicting better client functioning at termination solely for ethnoracially diverse clients.

Conclusion: These findings underscore the importance of integrating cultural humility instruction in training programs and therapeutic standards to promote mental health equity.

Objective: This study aims to review and synthesise qualitative studies of the subjective experiences of clinicians working with adolescents (11-18 years of age) who self-harm.

Method: We conducted a systematic literature search and included 14 studies in a meta-synthesis, applying Noblit and Hare's (1988) [Meta-ethnography - synthesizing qualitative studies. SAGE Publications] seven analytical steps for meta-ethnography.

Results: The meta-synthesis resulted in three meta-themes that narrate a process of the emotional experiences of being in a professional relationship with adolescents who self-harm: (1) "Sharing the pain - The relationship as a vehicle to help, understand, and protect"; (2) "Carrying the pain - Self-harm evokes strong feelings"; and (3) "Tolerating the pain - To show a way out".

Conclusion: Working with self-harm may represent a challenging balance for clinicians between exploring the pain in the therapeutic relationship, while also managing their own ability to tolerate the difficult emotions in this work.

Objective: Exposure to family violence in childhood significantly increases the risk of developing severe psychiatric and physiological illnesses. Trauma-focused cognitive behavioural therapy (TF-CBT) effectively addresses trauma-related symptoms and improves overall well-being. However, knowledge of the persistence of these positive effects over time, facilitating factors, and why some children are not benefited remains limited. Furthermore, little attention has been paid to exploring children's subjective experiences. This study aimed to investigate long-term changes in trauma-related symptoms among children and youths who underwent TF-CBT due to family violence. Nine participants (M age = 16,6 years, range = 14-23; 7 girls and 2 boys) were assessed and interviewed four to five years after TF-CBT treatment.

Methods: The study adopted a mixed-method approach, integrating quantitative and qualitative methods.

Results: While most participants still reported being affected by the violence, most had benefited from treatment, with improvements lasting over the years. However, for those who did not report decreased symptoms, trauma symptoms persisted, accompanied by additional severe mental health problems.

Conclusions: The findings underscore the importance of providing effective trauma-focused treatments such as TF-CBT and highlight the need for enhanced safety measures and parental interventions for children who do not benefit from treatment.

Objective: Emotion-focused skills training for parents (EFST) is a parental guidance intervention aimed at strengthening emotional bonds between parent and child and improve children's mental health. In this randomized controlled trial (RCT), EFST was compared to treatment as usual (TAU) in a Norwegian public outpatient clinic for child and adolescent mental health. The hypothesis was that EFST would be equal or superior to TAU in effectiveness on remission of diagnoses and symptomatic change for children.

Method: Seventy-two clients were randomly assigned to an EFST intervention or an integrative family-based intervention (TAU). The main outcome measure was the semi-structured diagnostic interview Schedule for Affective Disorders and Schizophrenia (K-SADS-PL), administered at pretreatment and after three months. The secondary outcome was the DSM-IV version of the Strengths and Difficulties Questionnaire (SDQ). Bayesian statistical methods, including clinically informed priors, were used to compare the effectiveness of the two interventions.

Results: Forty-four percent (15 of 34 clients) attained diagnostic remission in the EFST condition compared to 26 percent (10 of 38 clients) in TAU. The proportion of symptomatic decline was equivalent in both conditions.

Conclusion: The results support the hypothesis that EFST was equal or superior to TAU in effectiveness in a public outpatient setting.

Objective: In this review, we explore challenges and factors related to the scientist-practitioner gap in psychotherapy.

Methods: We systematically reviewed the literature and conducted a qualitative thematic analysis describing the science-to-practice gap. We summarized various definitions and identified themes related to the science-to-practice gap in psychotherapy.

Results: Specific to psychotherapists, factors such as more scientific education, a cognitive-behavioral school orientation, and personal preferences reduce the gap. Moreover, as contextual factors, institutional support, incentives for employing evidence-based interventions, and supportive working environments foster more adherence to the principles of Evidence-Based Mental Health (EBMH). There are concerns about the validity and applicability of research evidence for clinical practice, including criticism of rigid research methodology that neglects the individuality of the therapeutic relationship, patients, and treatment complexity. Various epistemological assumptions influence the gap between science and practice. In addition to identifying strategies for bridging the gap, such as dialogue and collaboration between scientists and practitioners, we included a historical examination of the codes showing the trends of different themes over time.

Conclusion: We encourage dialogue between research and practice, a discussion on research priorities, clinical perspectives, diverse methodologies, individualized treatments, therapist practices, and policy incentives.

Objective: This study aimed to evaluate whether apprenticeship training could enhance facilitative interpersonal skills (FIS) in first-year students enrolled in a six-year integrated clinical psychology study program, compared to training-as-usual.

Method: A total of 108 students were recruited and randomly assigned to either training-as-usual or training-as-usual plus apprenticeship. Students in the apprenticeship group participated in one weekly therapy session with different therapists over 10 weeks. FIS were assessed using a performance-based observer-rated test before and after the intervention.

Results: The apprenticeship group showed a significant improvement in FIS from pre- to post-intervention (d = 0.43, 95% CI [0.19, 0.67], p = .001), while the control group showed a small, non-significant improvement (d = 0.16, 95% CI [-0.06, 0.39], p = .16). The between-group difference was not statistically significant but showed a small effect in the expected direction (d = 0.24, 95% CI [-0.09, 0.58], p = .15). The largest gains were seen in the skills Alliance Bond Capacity and Alliance Rupture Repair Responsiveness.

Conclusion: While the between-group difference was not significant, the within-group improvement and the small observed effect favoring the apprenticeship group suggest that apprenticeship may be a valuable supplement to traditional training methods typically employed in early training.

Objective: Digital mental health interventions (DMHIs) offer scalable solutions to traditional barriers in mental healthcare. Acceptability of DMHIs might differ among patients with differing level of symptoms and relational difficulties. This study investigated how a person's psychological profile, including their level of mental health symptoms, epistemic trust, and attachment security, predicts their acceptance of AI-based interventions (avatars, chatbots) versus human-delivered teletherapy.

Method: Using cluster analysis on survey data from 1,612 (potential) patients and clinicians recruited via Prolifc, we identified three distinct psychological profiles: "Avoidant-not trusting," "Secure-trusting-healthy," and "Young-anxious-ambivalent-symptomatic."

Results: Results showed a paradoxical pattern: Individuals in the two most vulnerable clusters ("Avoidant-not trusting" and "Young-anxious-ambivalent-symptomatic") demonstrated significantly higher acceptance of AI-based DMHIs. In contrast, the psychologically healthier "Secure-trusting-healthy" cluster showed the lowest AI-based DMHI acceptance and the highest acceptance of teletherapy. Also, having therapy experience as provider or patient was associated with lower AI acceptance in general.

Conclusion: These findings suggest that AI-based interventions may be uniquely suited to reach individuals who struggle with human-to-human therapeutic relationships, thereby serving as a critical entry point to care for those who need it most. However, those vulnerable people might also miss out on the relational learning that takes place in human-based therapies.

Objective: Alliance rupture frequency and absence of repair are associated with poorer therapeutic outcomes. Prior research suggests different diagnoses may show distinct rupture patterns, with personality disorder (PD) treatments often displaying higher rupture rates compared to other diagnosis. Evidence, however, remains insufficient to inform clinical practice. This study aimed to expand knowledge on frequency of rupture markers and use of repair strategies across diagnoses and examine their relationship to outcome.

Method: In a naturalistic setting, 392 video-recorded sessions from nine PD and seven anxiety disorder (AD) treatments were rated with the Rupture Resolution Rating System. Outcome was assessed with the Symptom Checklist (SCL-92), and mixed-effect models compared groups across timepoints.

Results: No statistically significant differences were revealed between the groups in the comparison of frequency of rupture markers and repair strategy use. A trend toward more patient-initiated confrontation rupture markers in PD was observed. Higher patient-initiated rupture marker frequency correlated with greater symptom severity on five SCL-92 subscales somatization, anxiety, phobia, paranoid ideation, and psychoticism but not with the global severity index.

Conclusion: Findings indicate that patient-initiated rupture marker frequency is linked to treatment outcome. Frequency of rupture markers and repair strategy use might vary individually in naturalistic clinical settings, but the limited sample size warrant further study.

Objective: This study explored relational dynamics within a supervisory relationship, focusing on power, multicultural considerations, and parallel processes. Method: Guided by Gadamerian philosophical hermeneutics, the exploration relied on an iterative, reflexive engagement with eight recorded supervision sessions to interpret how these dynamics unfolded across time. Reflexive thematic analysis was used within a hermeneutic framework to identify relational patterns, and the Shedler-Westen Assessment Procedure served as an additional interpretive layer, providing the supervisor's professional perspective on supervisee personality tendencies. Results: Findings highlighted consistently fluctuating power negotiations, relationally embedded meanings shaping safety and disclosure, and tentative parallel processes that reflected patterns described in the supervisee's site supervision and client work. These dynamics appeared as interpretive layers rather than fixed mechanisms, emerging through the dialogical flow of supervision. Conclusion: The study offers process-level insights into how relational dynamics take shape within lived supervision, illustrating the value of hermeneutic inquiry for understanding supervision as an unfolding interpersonal experience. Implications for supervisors include attending to relational patterns as tentative cues for deeper inquiry.