Psychotherapy Research最新文献

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.

AbstractPsychotherapy expectations are considered one of the common factors influencing therapeutic success. Two broad dimensions of psychotherapy expectations have been identified: expectations about treatment benefits (outcome expectations/OEs) and expectations about the therapy process (treatment expectations/TEs). Both dimensions have been previously investigated; however, the evidence of TEs has been restricted by methodological limitations and the lack of an overarching theory to guide in-depth investigations. This state of affairs likely contributes to an ongoing under-estimation of expectation effects in psychotherapy, which tend to lag behind current knowledge about placebo effects. The aim of this paper is to present the rationale for adopting a "lay theory of psychotherapy" approach as a conceptual model for TEs. Based on its theoretical assumptions, it is suggested that these lay theories of psychotherapy can be operationalized as individuals' change process expectations, or what individuals view as the expected mechanism producing therapeutic change. Core components of lay theories and their operationalization as change process expectations are discussed, including their associations with process, role, and duration expectations, their dynamics, their associations with OEs, and their predictive effect on therapy outcomes. A review of literature supporting this model is presented, as well as directions for future research assessing its validity.

Objective: It is unclear whether cognitive reactivity (CR), an indicator of depression vulnerability, is reduced after cognitive behavioral therapy (CBT), as theorized. It is also unclear whether baseline CR and dysfunctional attitudes (DA) are associated with treatment outcome in CBT for depression. This study aims to examine these questions and assess if these effects are specific to CBT for depression.

Method: Depressed adult outpatients (n = 159) randomized to 16 sessions CBT or short-term psychodynamic supportive therapy (SPSP) completed measures of depression severity and CR at baseline and post-treatment (week 22), DA at week 5, and depression severity at baseline, week 5 and 10, and post-treatment. Mixed-model analyses were applied to estimate CR change and the moderating effect of DA and CR on depression levels at post-treatment.

Results: CR decreased significantly with a medium effect size. CR was negatively associated with post-treatment depression levels. DA was inconsistently associated with treatment outcome. We found no indications that these findings were specific to CBT.

Conclusion: CR decreases in both CBT and SPSP, broadening treatment options. CR, and possibly DA, appear to be prognostic factors for treatment outcome, potentially indicating the need to consider additional or alternativetreatment.

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.

Objective: Our primary aim was to assess the associations between outcomes and therapist interpersonal skills (TIS) of empathy, congruence, regard, and unconditionality, as rated by young people. We also aimed to compare these associations against outcome-alliance associations, and to assess whether these associations were specific to a TIS-prioritizing therapeutic practice.

Methods: Our primary sample was 167 13-16-year-olds who exhibited emotional symptoms and received up to 10 weeks of school-based humanistic counseling plus pastoral care as usual (SBHC + PCAU). Young people were predominantly female (76%), with 45% Black or other minoritized identity. We measured TIS with the Barrett Lennard Relationship Inventory; and used linear regression modeling to assess TIS associations with outcomes on psychological distress, wellbeing, and satisfaction.

Results: TIS, most markedly congruence, were significantly associated with outcomes, contributing approximately 3% of change. TIS and alliance explained similar proportions of outcomes, with a model including only congruence showing the best fit on psychological distress and wellbeing. We did not find consistent evidence that the TIS-outcome association was specific to humanistic counseling.

Conclusion: Therapists and lay professionals working with young people should strive to develop their interpersonal skills-particularly congruence-within the context of other relationship skills, qualities, and characteristics.

Objective: We assessed a new methodological and analytical approach for examining how therapist moment-to-moment interpersonal flexibility and responsiveness influence subsequent client collaboration. Therapist interpersonal flexibility was conceptualized as one of the crucial components of interpersonal responsiveness and operationalized as adjustments in therapists' interpersonal behaviors between speaking turns. To uncover the context-dependent nature of the responsiveness, the study also explored how these turn-to-turn adjustments, in relation to previous client collaboration, influence subsequent client collaboration. Method: This study involved 1107 speaking turns nested in 12 sessions nested within three therapist-client dyads. Three raters assessed therapist interpersonal behaviors in dominance-submission and approach-avoidance dimensions for each therapist speaking turn and the level of client collaboration for each client speaking turn. Distance scores and Dynamic Structural Equation Modeling (DSEM) were used to explore the hypothesized effects at a within-session level. Results: We found when therapists adjusted their interpersonal styles to a moderately high degree, clients were more collaborative than usual. We also found therapist turn-to-turn adjustments had a significantly positive effect on subsequent client collaboration only when clients were not collaborative before such adjustments were made. Conclusion: Overall, this study offers a methodological advancement in the study of therapist responsiveness by demonstrating the nuanced clinical insights offered by use of sophisticated analyses (i.e., within-session moment-to-moments responsiveness, Euclidean distance scores, Dynamic Structural Equation Modeling [DSEM]). Findings suggest a moderate level of turn-to-turn interpersonal adjustment may benefit subsequent client collaboration. Findings also suggest that a therapist's turn-to-turn adjustment in response to previous low client collaboration may facilitate subsequent client collaboration. Strengths, methodological limitations, and clinical implications are discussed.

Objective: Dropout is a major factor undermining the effectiveness of psychotherapy, however, it remains poorly anticipated in clinical practice. Classification trees may offer simple, accessible, and practical solutions to identifying patients at-risk of dropout by synthesizing potentially complex patterns of relationships among intake measures. Method: Intake variables were collected from day-patients who attended a Cognitive Behavior Therapy (CBT) group program at a private psychiatric hospital between 2015 and 2019. Based on these variables, two classification trees were trained and tested to predict dropout in (1) a weekly group, and (2) an intensive daily program. Results: Dropout was lower in the intensive treatment (Weekly CBT = 21.9%, Daily CBT = 13.2%), however, in both programs, the number of comorbid diagnoses was the most important factor predicting dropout. Overall balanced accuracy was comparable for both tree models, with the Weekly CBT model identifying 63.18% of dropouts successfully, and the Daily CBT model identifying dropouts with 62.06% accuracy. Conclusion: Findings suggest that comorbidity may be the most important factor to consider when assessing dropout risk in CBT, and that dropout can be predicted with moderate accuracy early in therapy via simple models. Furthermore, findings suggest that condensed, intensive treatments may bolster patient retention.

Objective: This study examines if experiencing the sequence of primary maladaptive emotions followed by primary adaptive emotions in-session predicts therapeutic change and whether this sequence mediates the impact of therapist emotional reflections on outcomes at post-treatment and follow-up.

Method: Nineteen participants with high self-criticism underwent 10-12 sessions of emotion-focused therapy (EFT). Therapist responses focusing on emotions, thoughts, and actions were coded for two sessions (sessions 6-12) during the initial 10 minutes prior to chair work. Clients' emotional states were coded using the Classification of Affective Meaning States (CAMS) during the subsequent chair work. Self-criticism and depression were measured at pre-treatment, post-treatment, and 3-month follow-up.

Results: Primary maladaptive emotions and the transformational sequence (primary maladaptive followed by adaptive emotion) predicted reductions in self-criticism at post-treatment, with the transformational sequence also predicting improvements at follow-up. The impact of therapist focus on emotions on depression and self-criticism at post-treatment and follow-up was mediated by the transformational sequence.

Conclusion: The transformational sequence predicts therapeutic outcomes and mediates the impact of therapist responses focused on the client's emotion and therapeutic results. Implications for therapist training are discussed.