Psychotherapy Research最新文献

Objective: Routine Outcome Monitoring (ROM) in group psychotherapy has shown varied results, as personalizing therapy for multiple patients is challenging. This study explored the impact of ROM and individual Add-On Interventions (AOIs) for patients with depression who were not progressing during Group Cognitive Behavioral Therapy (GCBT). We followed the research question, "How can individual AOIs contribute to patients' therapy courses?".

Method: We interviewed patients and therapists involved in GCBT with ROM and individual AOIs prompted by Not-On-Track alerts. Thematic analysis was used to generate themes related to participants' experiences. Three cases were selected to illustrate the structure of the themes.

Results: The main theme, "AOIs: Potential for active engagement," was constituted by seven subthemes concerning the influence of ROM, therapeutic collaboration, shared decision-making, allowing for person-tailored interventions, and the dynamic between group and individual sessions. The potential for active engagement was nurtured through flexible awareness, as patients shifted between a first-person perspective and an external perspective on their therapy process.

Conclusion: Individual AOIs, prompted by patient feedback, could create opportunities for reflection and engagement. However, the impact was shaped by the therapeutic relationships, the shared decision-making process, and the extent to which the AOIs offered complementary approaches to group psychotherapy.

Objective: Maintaining relevance in a psychodynamic dialogue is a nuanced task, requiring therapists to balance between following patients' free associations while avoiding less effective interventions. Identifying less effective sequences of talk is especially challenging given the diversity of psychodynamic approaches and methodological barriers to analyzing session discourse. This study introduces a novel approach using the MATRIX coding system, an evidence-based tool, to differentiate content correlated with better session outcomes.

Method: Transcripts of 367 sessions were coded using the MATRIX. Therapist Out-of-MATRIX utterances, indicating a deviation from core therapeutic focus, were examined for their predictive value. Outcome measures included the next-session alliance and patient functioning scores. Two machine-learning-based models, using the Random Forest algorithm, predicted session-by-session changes in clinical outcomes based on MATRIX codes, and interpreted using the SHapley Additive exPlanations.

Results: Therapist Out-of-MATRIX utterances accurately predicted next-session changes in alliance and patient functioning scores. Our model also identified an optimal dose-effect relationship for the number of Out-of-MATRIX interventions needed for effective therapy session.

Conclusion: This study demonstrates the potential of using contemporary research tools to analyze therapeutic discourse, revealing how psychotherapy produces its benefits. Its scope extends beyond prediction, providing practical recommendations on how to enhance therapists' performance and outcomes.

Objective: Previous research has identified a complex relationship between client-therapist synchrony and therapy outcomes. We investigated the ways in which depression severity influences this relationship.

Method: The sample was comprised of 30 clients undergoing a 16-session supportive-expressive dynamic therapy for depression. Client-therapist interpersonal synchrony was assessed using the Client-Therapist interpersonal Synchrony (CIB) coding system during five pre-selected sessions. After each session, the clients evaluated their satisfaction with the session. We employed multi-level modeling (MLM) to analyze the data.

Results: Sessions characterized by higher levels of interpersonal synchrony were associated with better session quality, both within and between dyads. Depression severity moderated this association, such that the correlation between interpersonal synchrony and session outcome was weaker in dyads where clients reported greater depression severity.

Conclusions: These findings suggest that to facilitate effective synchrony it is important to consider the clients' level of depression.

Objective: Patients with Major depressive disorder (MDD) and a comorbid Borderline personality disorder (BPD) show a poorer prognosis for MDD compared to patients without BPD. Little is known about the therapeutic processes underlying this prognosis. The goal of the present study was to investigate whether patients with more severe BPD symptoms experience less strengthening in patient-therapist movement synchrony (MS) throughout treatment, and whether less strengthening in MS is associated with less effective sessions. Method: Ninety-five patients participating in a randomized control trial were assessed for BPD (N = 9) using the Structured Interview for DSM-IV Personality. 1367 video-taped sessions were analyzed for MS using Motion Energy Analysis. Session effectiveness was evaluated following each session using a one-item scale taken from the Helping Skills Measure. Multilevel models were used to assess whether BPD severity predicted MS throughout treatment, and whether MS predicted session effectiveness. Results: Patients with more severe BPD symptoms experienced greater strengthening in MS throughout treatment. Less MS strengthening was associated with less session effectiveness. Conclusion: These findings indicate unique therapeutic processes that characterize individuals with more severe BPD symptoms. Shedding light on these unique processes has the potential to contribute to the personalization of MDD treatment for patients with BPD.

Objective: Countertransference (CT) has been shown to interfere with therapy goals, and its management is crucial to desired treatment outcomes. As a first step, a clinician's awareness of their covert and overt CT reactions is critical to successfully managing CT. Research on CT awareness is scarce, however, mainly because of difficulties in empirically investigating and measuring this construct. In this study, we sought to develop and validate two instruments: one to measure CT feelings and one to measure CT behaviors.

Method: We developed the Countertransference Feelings Awareness Measure and the Countertransference Behavior Awareness Measure, both composed of 12 items comprising 3 dimensions: dominant, hostile and distant. A sample of 245 Italian and 110 American clinicians participated in the research. Confirmatory factor analysis was conducted to verify the factor structure of the measures. Reliability and invariance analyses were conducted for both measures and both samples.

Results: Factorial structure, reliability, and configural invariance across nationalities of both measures were confirmed.

Conclusion: These tools should prove useful for future research, supervision, theoretical advances, and clinical application, allowing a deeper understanding of how clinicians' awareness of different elements of their CT experience impacts the outcome of therapy.

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.