Psychotherapy Research最新文献

Objective: Remote forms of psychotherapy became more common during the COVID-19 pandemic, increasing the importance of understanding how technological factors might affect remote treatment. Past research on other modes of communication suggests that perceptions can be influenced when the audiovisual quality of online communication is distorted. The aim of the current research was to examine the potential influence of visual or audio distortions during online therapy.

Method: 263 participants judged the interpersonal characteristics and skill of a psychotherapist after viewing segments of treatment sessions in either a video or audio-only format and where the presentation was either clear or distorted.

Results: Contrary to expectations, participants who viewed a poorer quality version of a therapy segment perceived the therapist to have more positive interpersonal characteristics than those who saw a segment of higher quality. There was no reliable difference in perception of the therapist's skill as a function of segment quality.

Conclusion: The findings from the study suggest that perceptions of a therapist are not adversely affected if the video or audio quality of a remote therapy session is less than ideal. Therefore, these technical aspects of online treatment may not need to be a top concern.

Objective: Client non-attendance and drop-out are common challenges in psychotherapy, often framed as issues of client engagement. Less attention has been paid to how therapists respond to these events, particularly within cognitive behavioural therapy (CBT). This study explores CBT therapists' cognitive, emotional, and behavioural responses to client non-attendance and drop-out using qualitative methods.

Methods: CBT therapists working in NHS or private settings were interviewed using a semi-structured format. Transcripts were analysed using Braun and Clarke's thematic analysis.

Results: Six overarching themes were developed, detailing the personal, contextual, and systemic factors that influence how therapists respond to non-attendance and drop-out.

Conclusion: These preliminary findings are consistent with previous literature in terms of cognitive and affective responses. A novel finding is CBT therapists' use of alternative approaches to manage their own distress. Implications for training and clinical practice are discussed.

Objective: Emotion regulation (ER) is increasingly recognized as a key mechanism in couple therapy. However, little is known about how ER changes across treatment or how early adverse events and current attachment experiences shape this process. Methods: Using a sample of 308 married individuals in couple therapy, this study examined changes in ER difficulties across a total of 24 sessions. We also tested whether adverse childhood experiences (ACEs) and current attachment insecurity (anxiety, avoidance) predicted baseline levels and changes in ER. Results: Multilevel modelling showed a small but significant decline in ER difficulties across sessions. Both ACEs and insecure attachment were associated with higher baseline ER difficulties. However, only avoidant attachment predicted greater improvement over time. ACEs and attachment anxiety were unrelated to change. Variance analysis revealed that most variation in ER occurred between individuals (70%) and within individuals over time (23%), with minimal variance at the couple (5%) and therapist (2%) levels. Conclusion: Findings support ER as a dynamic treatment target and underscore the importance of assessing developmental history and current attachment insecurity to guide intervention.

Objective: Chairwork describes a set of experiential techniques where different parts of the self or representations of others are placed into chairs and given a voice. Using chairwork, individuals can practice self-reflexivity, address internal conflicts, and develop greater acceptance of their self-parts. There is a dearth of research regarding chairwork with young people and little is known about how therapists perceive and implement chairwork with this population. This study aims to explore therapists' experiences of chairwork with children and adolescents.

Method: Twelve qualified therapists from seven countries who were trained in and had facilitated chairwork with young people were recruited using convenience sampling. Semi-structured interviews were conducted online and analysed using reflexive thematic analysis.

Results: Six themes were generated: "Playfulness and Creativity", "Working with the Developmental Needs of the Young Person", "Contextualizing the Young Person in their Relational World", "Facilitating Insight and Integration of the Self", "Overcoming Fear of Failure- Therapists' Professional Development", and "Therapist Agency and Confidence".

Conclusion: Therapists should seek to facilitate chairwork more effectively with young people by incorporating playful and creative methods, tailor the work to the young person's developmental stage, consider those in their relational system, and address therapist hesitations through peer support and supervision.

Objective: Given their professional developmental stage, couple and family therapy (CFT) students are likely to have clinical concerns or fears about potential negative experiences that could occur in their clinical work as they progress through their training. A recently developed self-report measure was used to increase awareness of these clinical concerns and ultimately decrease the potential of their negative impact during clinical care.Method: 71 CFT students (mostly female, 87.3%, and White, 70.4%) completed this measure and other potentially relevant measures (e.g., clinical self-efficacy, attachment security) at bi-monthly intervals throughout their clinical training.Results: Results suggest that clinical concerns decreased over the course of their training and that increases in clinical self-efficacy led to a greater decrease in clinical concerns over time.Conclusion: This study has important practical implications for clinical training programs, particularly for ways through which supervisors can support clinicians in growing awareness of potential clinical concerns, and their impact on care delivery.

Objective: The therapeutic alliance is a complex, relational construct that cannot be fully understood from a single perspective. Few studies have explored alliance dynamics from both therapist and client viewpoints in youth therapy. This case study investigates discrepancies in alliance ratings-alongside rupture and repair processes-in cognitive behavioral therapy for adolescent depression, where the adolescent consistently reported a stronger alliance than the therapist.

Method: A longitudinal mixed-method case study was conducted using data from the IMPACT-ME dataset, including session recordings, alliance ratings, and post-therapy interviews. The Rupture-Resolution-Rating System was applied to identify rupture-repair markers, and thematic analysis of post-therapy interviews with both adolescent and therapist provided additional context.

Results: The adolescent's high alliance ratings reflected a pattern of excessive compliance, concealing subtle withdrawal ruptures. The therapist, aware of this dynamic, rated the alliance lower and actively attempted to address the ruptures. Most ruptures were successfully repaired, and both parties ultimately described the relationship positively.

Conclusion: Discrepancies in alliance ratings can reflect complex relational processes rather than a weak alliance. In this case, they indicated a compliance-driven pseudo-alliance, which the therapist recognized and addressed. These findings underscore the importance of attending to subtle withdrawal behaviors, even in seemingly strong alliances.

Objective: To assess the frequency of alliance ruptures and repairs and their impact on treatment outcome in psychotherapy among patients with substance use disorder. The moderating effects of treatment orientation, attachment style and type of substance use were analyzed.

Methods: Eighty-three patients and six therapists reported alliance ratings after every session. The patients rated psychological distress before each session. Outcome was analyzed as change in psychological distress during the three sessions following a rupture and a repair. Ruptures were identified as an alliance drop in one session compared to the average scores of the three preceding sessions and repairs if alliance scores reached the levels before the rupture within the following three sessions.

Results: Fifty-two percent of the patients rated rupture(s) in the alliance, the therapists in 73% of the dyads. Patient-reported alliance ruptures, but not therapist-reported ruptures, contributed negatively to patients' psychological distress the following three sessions. Both patient- and therapist-reported repairs implied decreased psychological distress the following three sessions. A secure and a fearful attachment style moderated the relation between patient-reported alliance ruptures and deteriorated psychological distress.

Conclusion: Alliance ruptures seem to increase patient distress, while reparation is followed by decreased distress. Future studies may explore other moderators.

Objective: Postpartum depression (PPD) is common but undertreated, stressing the need for scalable psychotherapies. The reward system is a promising mechanism as PPD disrupts reward-supported behaviors: reduced motivation to engage in rewarding experiences (behavioral activation) and blunted pleasure during social interactions (social reward responsivity). Engage & Connect (E&C) is a simple and scalable psychotherapy, based on neuroscience literature. It aims to increase engagement in rewarding social experiences to restore reward-supported behaviors and reduce PPD.

Methods: In a one-arm pilot study, 38 women with PPD received 9-weeks of E&C. We tested whether E&C is feasible and acceptable. Using mixed-effects models, we tested whether E&C reduces PPD, mediated by improved reward-supported behaviors.

Results: We found that E&C was feasible and acceptable (86% retention). PPD severity significantly reduced during E&C (EPDS change = 8.6 points (SD = 3.8); 83% remission, 73% clinical response). Further, significant improvement in reward-supported behaviors (behavioral activation, social reward responsivity) mediated PPD reduction. Finally, anxiety severity, perceived social support, and infant bonding improved during E&C.

Conclusions: Results provide preliminary evidence that E&C may be a promising scalable first-line psychotherapy for PPD, pending testing in a randomized controlled trial. E&C might reduce PPD by improving reward functions with long-term benefits for mothers and infants. Clinical Significance: This pilot study suggested that Engage & Connect (E&C) is feasible and acceptable, with reduction in PPD and improvements in behavioral activation, social reward responsivity, social support, and infant bonding. Further, improvements in behavioral activation and social reward responsivity mediated PPD reduction. Pending replication in a larger sample, E&C may be a promising scalable first-line psychotherapy that reduces PPD by enhancing behavioral activation and response to social rewards.

Objective: A substantial number of therapists in the eating disorder (ED) field have experienced an ED themselves, yet research on professionals using their personal ED experience as a therapeutic tool is scarce. This study explores the perspectives of recovered ED professionals (REDPs) who intentionally employ their experiential knowledge in ED treatment, examining its use, advantages, and challenges.

Method: Semi-structured interviews were conducted with 20 REDPs using a topic list with open-ended questions based on our research aim and a previous literature review (Bijkerk et al., 2024).

Results: REDPs play a key role in treatment, with self-disclosure occurring in various forms. Experiential knowledge of REDPs offers benefits like motivation, hope, and understanding, but also challenges such as potential client burden or misguidance. Successful implementation of experiential knowledge requires organizational adjustments (supervision, work guidance and adequate training) and the REDPs' responsibility to create the right conditions for using their experiential knowledge efficiently.

Conclusion: Applying lived experience in practice by REDPs requires additional competence as it places these professionals into a difficult position of having to balance self-disclosure with ethical risks to clients and the risks to one's personal and professional self. Moreover, beneficial use of experiential knowledge in practice requires organizational support.

Objective: Uncertainty is an unavoidable aspect of healthcare service provision, particularly for psychologists who often navigate complex ambiguous clinical scenarios, which can evoke negative responses and increase risk of adverse outcomes. This study explores the willingness of Australian psychologists to communicate uncertainty to clients, identifying facilitators and barriers to this process.

Method: We surveyed 70 Australian psychologists providing direct client care. The survey focused on barriers and facilitators to communicating uncertainty through responses to a vignette depicting a common therapeutic scenario featuring uncertainty. Thematic analysis was undertaken using Nvivo.

Results: Key themes describing barriers included psychologist's internalization of uncertainty as personal and professional inadequacy, fear of negative client reactions, and a lack of skills in effectively communicating uncertainty. Conversely, facilitators included comfort with uncertainty, external professional supports, and strong therapeutic relationships.

Conclusions: The findings underscore the need for enhanced training of psychologists in uncertainty communication, focusing on developing adaptive responses and effective communication strategies. Addressing uncertainty is crucial given its inevitability, psychologist's pervasiveness discomfort with uncertainty and barriers to its communication. Future research should explore the nuanced experiences of psychologists in diverse practice settings working within a range of therapeutic modalities, and the impact of uncertainty on the therapeutic relationship.