Psychotherapy Research最新文献

Objective: Reflective practice is vital to high-quality therapeutic work, enabling clinicians to critically examine their professional practices. Increasing opportunities to engage in reflective processes stands to increase clinician wellbeing and thereby improve quality of care. Generative Artificial Intelligence (GAI), specifically large language models, provide new ways for clinicians to gain insight into their work. This study explores a unique unintended consequence of GAI clinical notetaking platforms, the support of reflective practice among mental health clinicians.Method: Semi structured interviews were conducted with clinicians (n = 17) to learn about their experience using GAI clinical note-taking platforms. Interviews were recorded and analyzed using a grounded theory approach to identify themes.Results: Respondents described how AI platforms functioned as a reflective partner by offering alternative clinical interpretations, lending clarity to their existing practice approach, and creating space to be more present during sessions.Conclusions: AI note-taking platforms are a feasible and scalable way to support reflective practice. Implications for clinical training and ongoing professional development are discussed, and opportunities for future research on the use of AI tools to enhance reflective practice are identified.

The focus on therapist variables and characteristics has significantly increased in psychotherapy research in recent years. While ethical considerations for patient-participants are well-established, the unique ethical dimensions of therapist-subjects remain underexplored. This theoretical paper examines three critical ethical aspects specific to therapist-participants: power dynamics in hierarchical relationships, personal-professional boundary issues, and confidentiality challenges. We analyze how these considerations manifest particularly in training contexts where researchers often hold supervisory roles over therapist-subjects (e.g., faculty supervising student-therapists). The paper explores the complex interplay between informed consent and institutional hierarchies, especially when participation may be perceived as professionally expected rather than voluntary. We examine the implications of recording and analyzing therapy sessions that expose therapists' personal characteristics and professional competencies, particularly when coded by colleagues within small professional communities. While existing ethical frameworks address research participants generally, they lack specific guidance for the unique vulnerabilities of therapists who are simultaneously research subjects and professional practitioners. We propose targeted considerations for ethical research design, including enhanced informed consent procedures, structural safeguards for managing power differentials, and privacy protections tailored to professional contexts. This theoretical exploration aims to highlight overlooked ethical complexities and guide future research practices when therapists serve as subjects in psychotherapy research.

Objective: There is limited research examining factors associated with Dialectical Behavior Therapy (DBT) treatment retention among veterans, who are of critical interest given higher rates of suicide and borderline personality disorder (BPD). This study examined factors related to DBT treatment retention and BPD symptom trajectories among veterans.

Methods: Participants were veterans enrolled in a comprehensive DBT program. 145 veterans presented to the program, and 115 veterans were deemed eligible and enrolled. The relationships between mental health care utilization, suicide-related factors, military-related trauma, and demographic variables with treatment retention and BPD symptom trajectories were examined.

Results: Older adults were more likely to complete at least a portion of treatment, and veterans with higher education were more likely to complete treatment. Regarding treatment outcomes, a past year suicide attempt was associated with heightened baseline BPD symptoms and sharper reductions in BPD symptoms. Having a recent emergency room visit was associated with sharper reductions in BPD symptoms.

Conclusions: These results begin the work of identifying factors associated with treatment retention and outcomes in this high-risk population-with the aim of informing research focused on understanding who is the most likely to benefit from DBT, as well as identifying potential factors to inform DBT program processes.

Objective: Clinical supervision is considered an important aspect of therapist training. However, little is known about which elements of supervision impact on therapist skills. The current study used a qualitative approach to identify patterns of (in)effective supervision sessions for novice CBT supervisees.

Method: Sixteen supervision sessions were selected, based on deviant case sampling from a larger randomized controlled trial investigating the effect of clinical supervision for psychology students. Nine effective and seven ineffective supervision sessions were chosen, based on changes in independently assessed competence and alliance scores from pre- to post-supervision. Transcripts of these sessions were analyzed using thematic analysis.

Results: The analysis yielded four themes, each structured into two sub-themes: Shaping Supervision through Supervisee Agency, The Supervisor as a Tailor, Co-Constructing Supervision, and Creating a Space to Learn. Effective supervision sessions were characterized by supervisees working actively on their individual goals, the use of a variety of supervisory techniques tailored to the supervisees' needs, a collaborative exchange at eye level, and a supportive and empowering atmosphere.

Conclusion: Our analysis identified theoretically and clinically relevant processes in supervision that may foster novice CBT supervisees' skills. It emphasizes the potential of personalized approaches, building on a supportive atmosphere.

Objective: Systemic therapy (ST) is a well-established treatment approach to reduce symptoms, yet its effects across outcome domains, informants, and assessment methods remain underexplored.

Method: We conducted a systematic literature review in multiple databases (PsycINFO, Pubmed, Embase, Cochrane CENTRAL), including RCT-studies comparing ST with a psychosocial control treatment for diagnosed children or adolescents. We conducted a three-level meta-analysis. Risk of bias was assessed using an adaptation for psychotherapy.

Results: Overall, we included 44 studies, 370 effect sizes, and 4617 families. The overall effect size was small but significant (g = .16, CI [.09, .23], p < .0001). Contrary to expectations, informants and assessment methods were no significant moderators. Effects were comparable across outcome domains including family functioning (g = .12), caregivers' psychopathology (g = .12) and patient symptoms (g = .19). Outcomes were mostly based on self-report symptom questionnaires, limiting interpretability.

Conclusion: Findings support that ST improves family functioning and caregivers' psychopathology, underscoring the need for more diverse outcomes.

Objective: This pilot randomized controlled trial (RCT) aimed to preliminarily assess the efficacy and acceptability of Cognitive behavioral therapy (CBT) and Emotion-focused therapy (EFT) in short-term treatment of depression within a Norwegian mental health program. The study also addresses procedural elements relevant for future research development.

Method: In a parallel two-arm RCT, 111 participants (mean age: 42, 70.6% female) with major depression were randomly allocated to 9-18 sessions of either CBT (n = 55) or EFT (n = 56). Five participants in CBT and four in EFT withdrew their consent, resulting in final sample sizes of CBT (n = 50) and EFT (n = 52). Self-reported depressive symptoms (BDI-II) were measured post-session and at 3-, 6-, and 12-month follow-ups. Data were analyzed using multilevel modeling.

Results: The results showed a significant improvement in symptoms from start to follow-up, as measured by the BDI-II (d = 0.56; 95% CI: 0.45, 0.66). No significant differences were found between conditions; however, the small sample size prevents definitive conclusions about possible differences. Drop-out was low (Total: 6.31%; CBT: 10.91%, EFT: 1.79%).

Conclusion: Our findings support the efficacy and acceptability of CBT and EFT in short-term treatment of depression in a Norwegian setting.Trial registration: ClinicalTrials.gov identifier: NCT04690946..

Objective: Although honesty is valued highly within psychotherapeutic work, therapists, like individuals in any interpersonal situation, are occasionally dishonest. The primary objective of this study was to explore clients' perceptions of therapist dishonesty, including their views on whether and under what circumstances therapist dishonesty is acceptable.

Methods: Participants (N = 566) were clients currently engaged in psychotherapy who completed an online Qualtrics survey (Clients' Assessment of Tact, Concealment, and Honesty; CATCH) and the Working Alliance Inventory.

Results: Most clients perceived their therapists to have been somewhat dishonest at least once during their treatment and believed it acceptable for their therapists to be dishonest about several topics, including their frustration or disappointment in clients. Clients who had a stronger working alliance perceived less therapist dishonesty and were more likely to view dishonesty as acceptable; these findings did not vary significantly by age, gender, race, or education level.

Conclusion: Clinical education on the varied nature and ethics of therapist dishonesty is indicated and ought to include discussion of instances in which less-than-complete honesty may be advisable, as well as its potential detrimental effects. Clinical training might well focus on beginning therapists' awareness of how their occasional dishonesty, including therapeutic tact, affects clients.

Objective: Intimate partner violence perpetrator (IPV) treatment interventions are traditionally associated with large dropout and low treatment adherence. Perceived working alliance is a proven predictor of treatment adherence and completion.

Methods: We measured patient (N = 199) and therapist (N = 30) working alliance after every treatment session during an 18-session cognitive behavioral group therapy for IPV perpetrators. We hypothesized that patient and therapist working alliance ratings would be strongly correlated and that both patient and therapist working alliance would be positively related to session attendance and treatment completion.

Results: Patient and therapist working alliance ratings remained fairly stable during the course of treatment and patients and therapists moderately agreed on their perception of their working alliance. The therapists' judgment of the working alliance strongly predicted session attendance and treatment completion, whereas the patients' working alliance ratings did not predict attendance nor completion. In line with previous studies, patients' age was positively associated with both session attendance and treatment completion.

Conclusion: The findings clearly indicate the importance of a positive working alliance from the start of group IPV perpetrator treatment, and that therapists should be on the alert if they perceive the working alliance as suboptimal because it predicts poorer attendance and dropout.

Objective: To explore parents' experiences of Family-Based Treatment (FBT) for Anorexia Nervosa (AN).

Method: Twenty semi-structured interviews with parents of young people (YP) in FBT at end of treatment (EOT), analysed via a combination of thematic and narrative analysis.

Results: The analysis identified three distinct themes, starting from a shared point of crisis marked by acute concern for their child's health and urgent need for intervention. Parents then travelled different routes shaped by challenges, support, and meanings they made over time. The Straight Road reflected strong alignment with FBT; parents found the process demanding but ultimately experienced strengthened relationships through shared recovery. The Bumpy Road was defined by initial disagreements with FBT and efforts to negotiate a more collaborative role for the YP, leading to deepened family relations. The Detoured Road was shaped by misalignment with FBT, often involving unmet support needs and relational strain not fully resolved by EOT.

Conclusion: Findings suggest that alignment with the principles of FBT plays a central role in shaping parental experiences. However, parents commonly described intense caregiving and strained family ties. Findings highlight the importance of assessing and supporting parental alignment with FBT, as misalignment may exacerbate caregiving strain and disrupt family dynamics.