Psychotherapy Research最新文献

Background: The Clinical Outcomes in Routine Evaluation (CORE) system was launched in 1998 intended to support the development of practice-based evidence and to reduce the research/practice gap. Since then, CORE instruments have been widely used.

Aims: To map the utilization of the CORE system as reflected in peer-reviewed literature.

Methods: We followed the guidelines for conducting a scoping review.

Results: We identified 721 papers from 1998 to 2021 citing the CORE system, with 636 of them referencing its use in clinical settings. There has been a marked increase in use of the system over that period. All CORE instruments were used at least once, spanning 39 countries and 24 languages. Papers had a broad spectrum of objectives and populations across diagnoses and settings, aligning with the authors' planned versatility for the CORE system.

Conclusions: In the light of the findings, we present a guide to enhance the reporting of work utilizing the CORE system. This could be applied to all practice-based evidence data collection, CORE or otherwise.

Objectives: This qualitative study explored changes described by individuals with complex dissociative disorders (CDDs) 2 years after participating in a psychoeducative group. Few recent studies have examined the early changes from incomprehensible reactions to the integration of traumatic events.

Methods: Interviews were conducted with 25 participants with CDD 2 years after completing a 20-week psychoeducative skills training group. Transcripts were analysed using an interpretive phenomenological framework.

Results: Three pathways of change were identified: (1) the ability to be present in life, (2) ways of approaching internal conflicts and (3) the degree of ownership of the self. These pathways illustrate the initial steps towards integration, in which participants start recognizing and confronting previously avoided emotions and experiences. This allows them to better tolerate and accept more of themselves. Processes varied among the participants, with some achieving cohesive integration of challenging memories.

Conclusion: Traditionally, there has been little treatment optimism for individuals with CDD. This study highlights the potential for comprehensive change within 2 years. It contributes to the debate on whether focusing on coping strategies delays trauma memory integration, emphasizing the need for a balance between exposure and coping based on the patient's capacity.

Objective: Men are more reluctant than women to engage with psychotherapy. Incels-an online community of involuntary celibates-have been identified as needing mental health intervention. Despite high rates of depression, suicidality, and social isolation, little is known about their therapy experiences or attitudes.

Methods: We collected 100 psychotherapy discussion threads from incels.is, the largest incel forum. Inductive thematic analysis identified community attitudes toward psychotherapy. We also coded the experiences of 89 users who reported attending therapy, quantitatively assessing therapist gender, motivation, and satisfaction.

Results: Among incels reporting therapy experiences, 70.8% reported negative outcomes and 7.9% reported satisfaction. None of those forced into therapy (25.8%) reported positive outcomes. Thematic analysis revealed barriers to engagement: (1) "blackpill" ideology attributing sexual/romantic deprivation to immutable factors; (2) conspiracy theories framing therapy as designed to sedate and control; (3) view of therapy as female-biased and hostile to men; (4) practical concerns including cost, privacy, and hospitalization.

Conclusions: Incels present intervention challenges due to their fatalistic worldview, institutional distrust, and extreme misogyny. Findings suggest potential benefits of male therapists and clear therapeutic goals that acknowledge but do not promise to resolve romantic concerns.

Objective: Therapist assignment can have a profound impact on the success of counseling. Accordingly, we present a framework that combines archival data and computer science algorithms to match clients to therapists so that client outcomes are, on average, better than assignment to the next available therapist while respecting each therapist's availability.

Methods: We estimated the association between therapists and clients' outcomes using high-dimensional data from CCAPS-62 and OQ-45 surveys from 2014 to 2019, obtained at a clinic of a large private university (exactly 10,100 courses of therapy). These predictions informed constrained client-therapist matches. We evaluated the method using simulations and statistical tests.

Results: Our model's predictions identified therapist-client pairs that are associated with an average improvement of client outcomes-0.145-3.65 OQ-45 points higher (d = 0.11) than usual, with 95% confidence, evaluated using out-of-sample data. Accounting for constraints on the availability of therapists (largely unconsidered in prior literature), our method could aid in improving outcomes with minimal impact on client wait times and few administrative changes necessary.

Conclusions: Improving client outcomes given therapist constraints through data-driven client-therapist matching might still retain a sizable portion of the benefit of data-driven matching.

Objective: Forming a strong therapeutic alliance (TA) with youth displaying antisocial behavior and psychopathic traits is challenging. This study explores factors influencing TA in therapy informed by Compassion-Focused Therapy (CFT), identifying key themes and strategies. Method: A qualitative study using semi-structured interviews with ten Finnish therapists experienced in working with this population. Participants used a CFT-based intervention designed to reduce psychopathic traits, shame, and fears of compassion. Data were collected between June and October 2024 and analyzed using thematic analysis. Results: Key themes influencing TA included respectful encounter, common humanity, trust, non-judgment, safeness, and stability. Therapists employed warmth, empathy, humor, and self-compassion techniques to strengthen TA. They emphasized consistency, clear communication, emotional validation, and an unhurried therapeutic presence to foster trust and engagement. Conclusion: Despite challenges, a strong TA with youth exhibiting psychopathic traits is achievable and critical for treatment success. CFT's emphasis on empathy, non-judgment, and stability supports TA formation. Specific strategies, such as warmth and consistency, help overcome engagement barriers and facilitate meaningful therapeutic relationships.

Objective: Impaired sustained attention, the ability to selectively attend to information and resist interference, has been associated with reduced response to cognitive therapies for posttraumatic stress disorder (PTSD; e.g., Crocker et al., 2018, Worse baseline executive functioning is associated with dropout and poorer response to trauma-focused treatment for veterans with PTSD and comorbid traumatic brain injury. Behaviour Research and Therapy, 108, 68-77). However, little is known about how attentional capacity impacts exposure-focused treatment. Further, as serotonin deficits relate to impaired sustained attention and SSRIs may enhance cognitive functioning, serotonergic antidepressants may moderate this impact.

Method: In 142 treatment-seeking individuals with PTSD, sustained attention was assessed using the flanker task prior to receiving prolonged exposure (PE) or PE plus sertraline.

Results: At pre-treatment, sustained attention was not strongly associated with PTSD or depression severity. Higher pre-treatment sustained attention was associated with greater pre-posttreatment reductions in PTSD symptom severity with a small to moderate effect (γ₁₁= -3.95, d = .46) and most predictive of lower avoidance symptoms (γ₁₁ = -0.61, d = .43). This effect did not achieve significance for depression severity. Treatment modality did not moderate this relationship.

Conclusion: Impaired sustained attention may be one moderator to consider towards treatment optimization. Research should examine specific in-session attentional mechanisms impacting outcomes such as reduced engagement with trauma-related stimuli during exposure.

Objective: To explore factors and processes surrounding sudden gains (SGs) in internet-delivered psychodynamic therapy (IPDT) for adolescent depression.

Method: Based on a randomized controlled trial, 22 patients' chat therapy sessions in close connection, both before and after an SG, were analyzed using reflexive thematic analysis, with a focus on the therapeutic process as well as the patients' descriptions of their improvement.

Results: In the majority of cases, SGs in IPDT were preceded by a process that can be summarized in four themes: "I worked hard with the support of my therapist; "I began to understand myself through the self-help materials"; "I applied my new understanding in everyday life"; and "I became more aware of my feelings and less self-critical."

Conclusion: SGs in IPDT seem to be not just statistical phenomena but meaningful psychological experiences, preceded by recurring therapeutic patterns extending over multiple sessions. In this process, engaged work facilitates the acquisition and application of new self-knowledge, leading to significant changes in emotional awareness and self-criticism.

Objective: The aim of this longitudinal study was investigating how specific dimensions of client expectations about counseling relate to the initial level and subsequent trajectory of the working alliance and symptom change in psychotherapy conducted by Chinese beginning therapist trainees. Methods: Participants included 173 Chinese therapist trainees and their 1,916 clients. At intake, clients completed a measure (Anderson, T., Patterson, C. L., McClintock, A. S., & Song, X. [2013]. Factorial and predictive validity of the Expectations About Counseling-Brief (EAC-B) with clients seeking counseling. Journal of Counseling Psychology, 60(4), 496-507. https://doi.org/10.1037/a0034222) assessing their expectations about counseling along three dimensions: Client Involvement, Counselor Expertise, and Facilitative Conditions. Before every session, clients reported their symptom severity level; after every session, both therapists and clients reported their perceived strength of the working alliance. Results: Multilevel modeling results showed that (1) clients with higher initial symptom levels showed lower expectations on Client Involvement (B = -.586, SE = .292, p = .045) but higher expectations on Counselor Expertise (B = .992, SE = .231, p < .001); (2) clients with higher initial working alliance ratings showed higher expectations on Client Involvement (B = .162, SE = .039, p < .001) and Facilitative Conditions (B = .152, SE = .033, p < .001); and (3) clients with higher expectations on Counselor Expertise appeared to show a greater average decrease in symptom level (i.e., greater improvement in therapy) over the course of therapy (B = -.060, SE = .024, p = .011). Conclusion: The findings confirms that client expectations, particularly for counselor expertise, are both a product of initial clinical factors and a predictor of therapeutic success. Conceptual and clinical implications, especially with regard to the Chinese cultural context, are discussed.

ABSTRACTObjective: Potential negative effects of psychological treatments are recognized in research, yet the attitudes toward their disclosure during the informed consent procedure remain unexplored. This study examined individuals' perception of receiving such information, investigating the awareness regarding deterioration, non-response, and new symptoms, and how this knowledge affects willingness to initiate treatment. Method: A mixed-method approach was used in relation to an online survey of adults in Sweden (N = 500, 75.6% women, age M = 38.2), including both individuals with (76.6%) and without prior experience of psychological treatments. Descriptive statistics, t-tests, one-way ANOVA, and Pearson's correlation tests were conducted to explore factors that might affect the willingness to initiate treatment, while thematic analysis was employed for open-ended responses. Results: The majority (72%) of respondents favored being informed, emphasizing the importance of transparency, realistic expectations, and preparedness. Common concerns included increased anxiety and hesitation toward treatment. No variable was related to the willingness to initiate treatment. Conclusion: Most respondents preferred disclosure of potential negative effects. Clinicians should incorporate information about potential negative effects into the informed consent procedure, balancing risks and benefits and explain the nocebo effect, thereby enhancing patient engagement, trust, and willingness to engage in treatment.

Objective: To test the psychometric properties of the five-item patient-rated Session Evaluation Scale (SES-P) (Study 1) and to create a three-item version (Study 2), and to test the psychometric properties of the five-item (Study 3) and three-item (Study 4) therapist-rated version (SES-T).

Method: Two independent samples of adult psychotherapy patients (N  =  1,043) and therapists (N  =  151) completed their respective versions of the SES along with other measures. Psychometric evaluation involved descriptive item analysis, item response theory analysis, confirmatory factor analysis (CFA), and multigroup CFA. Reliability and validity were also assessed. Psychometric scale shortening employed item response theory analysis.

Results: The patient- and therapist-forms of the five-item SES demonstrated strong psychometric properties, including excellent internal reliability (omega total ≥ .80), a clear unidimensional structure (CFI ≥ .95), and full measurement invariance across in-person and video-based session formats (tested only for the patient-form). The three-item versions retain sound psychometric properties (CFI ≥ .95; omega total > .75) and their scores demonstrated strong agreement and minimal bias with the five-item SES scores (Bland-Altman regression average discrepancy ranged from 0.227 to 0.282 points).

Conclusion: The SES-P and SES-T, especially in their ultra-short form, are reliable and psychometrically robust instruments for nuanced evaluation of session quality.