Psychotherapy Research最新文献

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.

Objective: Recently, several studies have examined the role of spiritual and religious (R/S) issues in psychotherapy. However, to our knowledge, no studies have systematically synthesised clients' qualitative perspectives on how these themes are addressed during sessions. The present study is a meta-synthesis of qualitative studies focusing on clients' experiences and perceptions of their R/S issues in individual or group secular psychotherapy contexts.

Methods: Original studies were identified by systematically searching six databases and conducting subsequent manual literature searches. A meta-aggregation approach was used to synthesise the findings from the primary studies.

Results: Fourteen studies met the inclusion criteria and quality appraisal. The meta-aggregation identified three synthesised findings: (a) R/S clients' experiences and perceptions of the therapeutic relationship, (b) R/S topics addressed in psychotherapy, and (c) client preferences for R/S integration in psychotherapy.

Conclusion: Clients valued therapists who were open, respectful, and able to incorporate their beliefs into treatment. This seemed to strengthen the therapeutic alliance. Some clients may view psychotherapy as a complement to their R/S practices, which could influence their perceptions and expectations of therapy. The main limitations were the small number of studies included, the restriction to English-language articles and secular settings, and the underrepresentation of non-Western/non-Christian cultures.

Introduction: Psychological pain is a central risk factor for suicidal behaviour. Nonverbal synchrony between patients and therapists has been shown to facilitate the development of therapeutic alliance, which in turn is linked to symptom reduction. Building on these associations, the present study investigated whether movement synchrony in suicide-specific therapy exceeds random synchrony and whether it is associated with patients' psychological pain. Method: A sample of 95 video recordings from therapy sessions of the Attempted Suicide Short Intervention Program (ASSIP) were analysed using Motion Energy Analysis to assess synchrony in head and upper body movements. Psychological pain was assessed using the Suicide Status Form II (SSF-II). Results: Genuine synchrony was significantly greater than pseudosynchrony t(110.16) = 4.314, p < .001, d = 0.49, 95% CI [0.005, 0.014], confirming the validity of the synchrony measurement. Additionally, movement synchrony was negatively correlated with psychological pain (r(84) = -.319, p = .003). This relationship remained significant after controlling for potential mediating factors (r(84) = -.302, p = .008). Conclusion: This study highlights the role of nonverbal synchrony in suicide-specific therapy, demonstrating that it exceeds random synchrony and is associated with lower levels of psychological pain.

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.